血清甲状腺球蛋白、促甲状腺激素联合检测对行甲状腺全切术后未接受清甲治疗的分化型甲状腺癌患者复发的预测价值

Predictive value of serum thyroglobulin and TSH for recurrence of differentiated thyroid cancer after total thyroidectomy without remnant ablation

目的探讨中低危分化型甲状腺癌(DTC)患者行甲状腺全切术(TT)后未接受清甲(RA)治疗时血清甲状腺球蛋白(Tg)水平和促甲状腺激素(TSH)水平对术后复发的预测价值。方法回顾性分析2014年1月至2019年7月间,在郑州人民医院接受TT的中低危分化型甲状腺癌患者112例,术后仅接受内分泌治疗未接受清甲治疗,无复发组(M0)105例、复发组(M1)7例。采用t检验、Mann⁃Whitney u秩和检验、χ^(2)检验和Fisher精确检验比较两组患者的基本临床病理特征,采用logistic回归分析筛选术后复发的独立影响因素,采用Spearman相关性分析探索Tg与TSH的关系,建立Tg、Tg/TSH与DTC复发的ROC曲线。结果两组间血清Tg、包膜侵犯、复发危险分层差异有统计学意义(P<0.05),性别、确诊年龄、肿瘤大小、淋巴结转移、TSH差异无统计学意义(P>0.05),其中Tg是DTC复发的独立影响因素。Tg与DTC复发关系的ROC曲线下面积为0.838,诊断界值为1.355μg/L,灵敏度85.7%、特异度82.9%。Spearman相关性分析结果显示Tg与TSH呈正相关,当Tg≥1.355μg/L时,M0组患者18例,M1组患者6例,两组患者中Tg/TSH差异有统计学意义(P<0.05),Tg/TSH与DTC患者复发关系的ROC曲线下面积为0.778,最佳界值为1.128,灵敏度66.67%、特异度100%。结论血清Tg、TSH联合检测可用于行TT后未接受RA的中低危DTC患者的术后随访,对疾病的复发有预测价值。

Objective To investigate the predictive value of serum thyroglobulin(Tg)and thyroid⁃stimu⁃lating hormone(TSH)for recurrence in intermediate and low⁃risk differentiated thyroid cancer(DTC)after total thyroidectomy(TT)without remnant ablation(RA).Methods This retrospective study engaged 121 patients with intermediate and low⁃risk differentiated thyroid cancer who received TT in Zhengzhou People's Hospital be⁃tween January 2014 and July 2019,with 105 patients in non⁃recurrence group(M0)and 7 patients in recurrence group(M1).The t test,Mann⁃Whitney U test,test,and Fisher's exact test were performed to evaluate the differ⁃ences in basic clinicopathological features among the 2 groups,and the logistic regression analysis was done to evaluate the independent influence on the recurrence of DTC patients.Spearman correlation analysis was done to ex⁃plore the relationship between Tg and TSH.The receiver operating characteristic(ROC)curve was analyzed to evaluate the predictive value of Tg and Tg/TSH for the DTC recurrence.Results Significant differences in the se⁃rum Tg,capsule invasion and recurrence risk were observed between the two groups(P<0.05),while no signifi⁃cant differences were seen in gender,age,tumor size,lymph node metastasis,and TSH between them(P>0.05).Tg was found to be an independent factor for the DTC recurrence.The areas under the ROC curve of Tg for predict⁃ing the DTC recurrence were 0.838.The cut⁃off value was 1.355μg/L,and the sensitivity and specificity were 85.7%and 82.9%,respectively.Spearman correlation analysis showed that Tg was positively correlated with TSH.When Tg was≥1.355μg/L,the number of patients reached 18 and 16 in the M0 group and the M1 group,respec⁃tively.There was a significant difference in Tg/TSH between the two groups(P<0.05).The areas under the ROC curve of Tg/TSH for predicting DTC recurrence was 0.778,the cut⁃off value was 1.128,and the sensitivity and specificity were 66.67%and 100.0%,respectively.Conclusion The combined detection of serum Tg and TSH can be used for postoperative follow⁃up of intermediate and low⁃risk DTC patients after TT without RA,and it is of value for predicting DTC recurrence.