乳腺癌改良根治术后血清甲状腺激素水平与肿瘤复发的相关性研究

Correlation between the serum levels of thyroid hormone and tumor recurrence after modified radical mastectomy in patients with breast cancer

目的研究乳腺癌改良根治术对患者甲状腺激素分泌水平的影响,并分析甲状腺素水平与乳腺癌复发的关联性。方法选取2018年4月至2020年4月收治的乳腺癌行改良根治术患者共96例为试验组,并以同期收集的80例健康体检者为对照组,收集2组血清,测定术前、术后3 d患者的血清总四碘甲状腺原氨酸(T4)、总三碘甲状腺原氨酸(T3)、游离四碘甲状腺原氨酸(FT4)、游离三碘甲状腺原氨酸(FT3)和促甲状腺激素(TSH)水平;回顾分析乳腺癌改良根治术后患者复发率;使用ROC曲线分析甲状腺激素水平对乳腺癌复发的影响和预测诊断价值。结果试验组血清中FT4、T3、FT3水平高于对照组(P<0.05),经改良根治术后,乳腺癌患者血清FT4、T3、FT3水平明显降低;TNM分期越高的乳腺癌患者其血清FT4、T3、FT3水平越高(P<0.05);乳腺癌改良根治术后乳腺癌复发组FT4、T3、FT3水平高于未复发组(P<0.05);多因素分析结果显示,FT4、T3、FT3是乳腺癌发病的危险因素;ROC曲线结果表明,FT4(P=0.027)=17.38 nmol/L时,对乳腺癌改良根治术诊断术后复发的特异性为77.19%,T3(P=0.042)=1.86 pmol/L时诊断乳腺癌改良根治术后复发的敏感性为83.33%,但特异性较低,而FT3不能用作乳腺癌改良根治性切除术后复发的诊断指标(P=0.175>0.05)。结论甲状腺激素水平的异常与乳腺癌具有一定的相关性,且为乳腺癌改良根治术后患者复发的危险因素,甲状腺素水平检测可能作为评估病情及判断预后的指标之一。

Objective To investigate the effects of modified radical mastectomy on the serum levels of thyroid hormone in patients with breast cancer,and ro analyze its correlation with breast cancer recurrence.Methods A total of 96 patients with breast cancer who were treated by modified radical mastectomy in our hospital from April 2018 to April 2020 were enrolled as experimental group,at the same time,the other 80 healthy subjects who underwent medical examinees were enrolled as control group.The serum levels of thyroid stimulating hormone(TSH),total tetraiodothyronine(T4),free tetraiodothyronine(FT4),total triiodothyronine(T3)before and at 3d after surgery,and the levels of free triiodothyronine(FT3)were detected.Moreover the recurrence rate of patients after modified radical mastectomy was observed,and ROC curve was used to analyze the effects of thyroid hormone levels on breast cancer recurrence and its predictive and diagnostic value.Results The serum levels of FT4,T3 and FT3 experimental group were significantly higher than those in control group(P<0.05).After modified radical resection,the serum levels of FT4,T3 and FT3 in experimental group were significantly decreased,and the higher the TNM stage,the higher the serum levels of FT4,T3FT3(P<0.05).And the levels of FT4,T3 and FT3 in relapse were significantly higher than those in non-relapse group(P<0.05).The multivariate analysis showed that FT4,T3,and FT3 were risk factors for breast cancer.The ROC curve results showed that when FT4=17.38nmol/L,the specificity for the diagnosis of postoperative recurrence of breast cancer was 77.19%,and the specificity of T3(1.86pmol/L)in diagnosis of postoperative recurrence of breast cancer was 83.33%,but its specificity was lower,moreover,FT3 could not be used as a diagnostic indicator for recurrence of breast cancer after modified radical mastectomy(P>0.05).Conclusion There is a certain correlation between the abnormal levels of thyroid hormone and breast cancer,moreover,which is one of the risk factors for recurrence of breast cancer after operation.The detection of thyroid hormone level may be regarded as one of the indexes to evaluate the disease condition and prognosis of patients.