持续/复发分化型甲状腺癌二次手术生存的影响因素

Analysis of influence factors in patients with persistent/recurrent differentiated thyroid cancer after secondary surgery

目的研究持续/复发分化型甲状腺癌二次手术患者3年无疾病生存期(DFS)及其影响因素。方法纳入江苏省原子医学研究所2015年4月至2017年4月160例持续/复发分化型甲状腺癌二次手术患者作为研究对象,术后随访记录3年DFS。采用Logistic多因素分析法分析影响患者预后的独立影响因素。结果160例患者二次手术后3年肿瘤进展28例,3年DFS为82.50%,将28例肿瘤进展者纳入观察组,132例未发生肿瘤进展患者纳入对照组。Logistic多因素分析结果显示,肿瘤直径≥4 cm和分期为Ⅲ期是持续/复发分化型甲状腺癌患者二次手术后无进展生存的危险因素(P<0.05),淋巴结清除是无进展生存的保护因素(P<0.05)。受试者工作曲线(ROC)分析结果显示,肿瘤直径判断预后的曲线下面积(AUC)为0.816,灵敏度为0.714,特异度为0.764,最佳截断值为5.1 cm;肿瘤分期和淋巴结清扫情况判断预后的AUC分别为0.754和0.693,灵敏度分别为0.857和0.643,特异度分别为0.652和0.742。结论持续/复发分化型甲状腺癌二次手术患者3年DFS与肿瘤直径、分期及淋巴结清扫情况有关。

Objective To study the 3-year disease free survival(DFS)and its influence factors in patients with recurrent/persistent differentiated thyroid cancer after secondary surgery.Methods One hundred and sixty patients with recurrent/persistent differentiated thyroid cancer from April 2015 to April 2017 were selected whose 3-year DFS were recorded.The Logistic multivariate analysis was used to analyze the independent factors influencing the prognosis of patients.Results Tumor progression occurred in 28 patients who received the secondary operation with DFS reaching at 82.50%.Twenty-eight patients with tumor progression were included in the observation group,and 132 patients without tumor progression were included in the control group.Logistic multivariate analysis showed that tumor diameter≥4 cm and stageⅢwere high risk factors for progression free survival in patients with recurrent persistent differentiated thyroid after secondary surgery(P<0.05).And lymph node clearance was a protective factor for progression free survival(P<0.05).The results of receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of tumor diameter to predict the prognosis was 0.816(P<0.05)with the sensitivity and specificity reaching at 0.714 and 0.764 respectively.And the best cutoff value was 5.1 cm.The AUC of tumor stage and lymph node dissection predicting the prognosis were 0.754 and 0.693.The sensitivity were 0.857 and 0.643,and the specificity were 0.652 and 0.742.Conclusions The DFS of patients with recurrent and persistent differentiated thyroid cancer after reoperation is closely related to tumor diameter,stage and lymph node dissection,which should be paid attention in clinic.