年龄及甲状腺球蛋白抗体阳性水平对分化型甲状腺癌预后的影响

The influence of age and thyroglobulin antibody positive level on the prognosis of differentiated thyroid cancer

目的在不同年龄段甲状腺球蛋白抗体(TgAb)阳性的分化型甲状腺癌(differentiated thyroid cancer,DTC)患者中,探讨经手术及131I治疗后的预后影响因素及TgAb水平及变化趋势等在DTC患者预后及随访中的价值。方法回顾性分析131例TgAb阳性的DTC患者临床资料,按照年龄分为年轻组(年龄<55岁,95例)与年长组(年龄≥55岁,36例),根据疗效评价分为疗效满意组(110例)和疗效不满意组(21例),采用χ2检验、t检验等比较不同组别间临床病理特征。通过logistic回归分析影响患者预后的独立危险因素。通过受试者工作特征曲线确定诊断DTC患者持续或复发的TgAb界值,以Kaplan-Meier回归曲线分析TgAb转阴时间。P<0.05为差异有统计学意义。结果在年轻组患者中,131I治疗前血清TgAb水平高及肿瘤合并颈侧区淋巴结转移是患者预后差的独立影响因素[OR=0.89(95%CI 0.83~0.95),OR=0.15(95%CI 0.05~0.52);均P<0.05],而年长组患者肿瘤腺外侵犯以及131I治疗前血清TgAb越高则患者预后越差[OR=0.05(95%CI 0~0.83),OR=0.91(95%CI 0.76~1.13);P<0.05]。预测DTC持续或复发的血清TgAb界值为315.5 IU/mL(年轻组为246.0 IU/mL,年长组为516.5 IU/mL)。所有患者血清TgAb平均转阴时间为(26.37±2.22)个月[年轻组为(23.28±2.37)个月,年长组为(32.64±4.07)个月],首次131I治疗后1年TgAb下降率>50%的患者发生疾病持续或复发的概率均低于未下降组(P<0.05)。结论在年轻组患者中131I治疗前血清TgAb水平高及合并颈侧区淋巴结转移是患者预后差的独立影响因素,而年长组肿瘤腺外侵犯以及131I治疗前血清TgAb越高患者预后越差,131I治疗后1年内TgAb的变化率可能可以作为预测TgAb阳性患者疾病状态的早期标志物。

Objective To investigate the prognostic factors of differentiated thyroid cancer(DTC)patients with positive thyroglobulin antibody(TgAb)and varying ages after operation and 131I treatment.To explore the value of TgAb level and its change in the prognosis of DTC patients.Methods Clinical data of 131 TgAb positive DTC patients were retrospectively analyzed.According to age,they were divided into young group(age<55 years,n=95)and elder group(age≥55 years,n=36).According to response,it was divided into excellent response group(110 cases)and non-excellent response group(21 cases).χ2 test and t test were used to compare the clinicopathological features between excellent response group and non-excellent response group.By logistic regression analysis,the independent risk factors affecting the prognosis of patients were analyzed.The receiver operating characteristic curve was used to determine the TgAb value of persistent or recurrent DTC,and the Kaplan-Meier regression curve was used to analyze the time of TgAb becoming negative.P<0.05 was statistically significant.Results In young patients,the higher serum TgAb level before 131I treatment and the lateral lymph node metastasis were the independent influencing factors of poor prognosis[OR=0.89(95%CI 0.83-0.95),OR=0.15(95%CI 0.05-0.52);both P<0.05].In elder group,extraglandular invasion and higher serum TgAb before 131I treatment were associated with poorer prognosis[OR=0.05(95%CI 0-0.83),OR=0.91(95%CI 0.76-1.13);P<0.05].The serum TgAb thresholds for predicting DTC persistence/recurrence were 315.5 IU/mL(246.0 IU/mL in the young group and 516.5 IU/mL in the elder group).The mean time TgAb sera turned negative was(26.37±2.22)months[(23.28±2.37)months for young group and(32.64±4.07)months for elder group].The TgAb decreased>50%in one year of the patients who had a lower probability of disease persistence/recurrence than the group without(P<0.05).Conclusions The high level of serum TgAb before 131I treatment and lateral lymph node metastasis were independent factors of poor prognosis in young patients,while in elder patients,extraglandular tumor invasion and the high level of serum TgAb before 131I treatment were independent factors of poor prognosis.The rate of TgAb change one year after treatment may be used as an early marker for predicting the disease status of TgAb positive patients.