分化型甲状腺癌患者术后复发转移的临床指标及相关影响因素分析

Analysis of Clinical Indexes and Related Influencing Factors of Postoperative Recurrence and Metastasis in Patients with Differentiated Thyroid

目的 分析分化型甲状腺癌(DTC)患者术后复发转移的临床指标及相关影响因素。方法 选择122例DTC患者。术后随访2年,收集患者基本资料、病理资料及手术治疗情况;依据随访患者术后复发转移与否将其分为复发转移组与未复发转移组。测定两组甲状腺球蛋白(TG)水平,并进行超声检查。比较两组TG水平及超声检查结果,并采用多因素Logistic回归方法分析DTC患者术后复发转移的相关影响因素。结果 122例DTC患者术后出现复发转移31例,复发转移率为25.41%(31/122);术后复发转移组TG水平高于未复发转移组,复发转移组点状强回声、低回声占比高于未复发转移组,有统计学差异(P<0.05);复发转移组年龄≥50岁、术前淋巴结转移、肿瘤直径≥5 cm、TNM分期Ⅲ期+Ⅳ期患者占比高于未复发转移组,有统计学差异(P<0.05);两组在性别、病理类型、手术方式方面对比,无统计学差异(P>0.05);采用Logistic回归分析显示,术前淋巴结转移、肿瘤直径、TNM分期为影响DTC患者术后复发转移的独立危险因素(P<0.05且OR≥1)。结论 TG及超声检查可作为预测DTC患者术后复发转移的参考指标,影响DTC患者术后复发转移的独立危险因素包括术前淋巴结转移、肿瘤直径、TNM分期,需要加强对DTC患者术后的随访监测与观察。

Objective To analyze the clinical indexes and related influencing factors of postoperative recurrence and metastasis in patients with differentiated thyroid cancer(DTC).Methods 122 patients with DTC were selected.The patients were followed up for 2 years to collect the basic data,pathological data and surgical treatment;According to the postoperative recurrence and metastasis,the patients were divided into recurrence and metastasis group and non recurrence and metastasis group.The levels of thyroglobulin(TG)in the 2 groups were measured and examined by ultrasonography.The TG level and ultrasound results of the 2 groups were compared,and the related factors of postoperative recurrence and metastasis in patients with DTC were analyzed by multivariate logistic regression.Results recurrence and metastasis occurred in 31 of 122 patients with DTC.The recurrence and metastasis rate was 25.41%(31/122);The TG level in the recurrence and metastasis group was higher than that in the non recurrence and metastasis group,and the proportion of punctate strong echo and low echo in the recurrence and metastasis group was higher than that in the non recurrence and metastasis group(P0.05);Logistic regression analysis showed that preoperative lymph node metastasis,tumor diameter and TNM stage were independent risk factors for postoperative recurrence and metastasis in patients with DTC(P<0.05 and or ≥1).Conclusion TG and ultrasonography can be used as reference indexes to predict postoperative recurrence and metastasis of DTC patients.The independent risk factors affecting postoperative recurrence and metastasis of DTC patients include preoperative lymph node metastasis,tumor diameter and TNM stage.It is necessary to strengthen postoperative follow-up monitoring and observation of DTC patients.