分化型甲状腺癌外科切除联合碘-131及TSH抑制治疗后复发危险因素分析

Analysis of risk factors for recurrence of differentiated thyroid carcinoma after surgical resection combined with iodine-131 and TSH suppression therapy

目的:探讨分化型甲状腺癌(differentiated thyroid cancer,DTC)外科切除联合碘-131(131I)及促甲状腺激素(thyroid stimulating hormone,TSH)抑制治疗后复发的危险因素。方法:回顾性分析2015年1月-2020年4月解放军总医院第一医学中心接受外科手术联合131I及TSH抑制治疗后,随访发生结构性复发和未复发患者的临床资料。分析比较两组患者的一般情况,符合正态分布的计量资料,组间比较采用t检验;非正态分布的计量资料,组间比较采用秩和检验;计数资料组间比较采用χ^(2)检验。采用单变量和多变量回归分析确定与复发相关的危险因素。结果:中位随访周期为43个月(18~81个月),955例患者中,复发100例(10.5%)。单因素分析显示,肿瘤大小、肿瘤多发、颈部中央区淋巴结转移数>5个、颈侧区淋巴结转移数>5个与治疗后复发显著相关(P<0.001、P=0.018、P<0.001、P<0.001)。多变量分析显示,肿瘤大小(调整后的比值比OR:1.496,95%CI:1.226~1.826,P<0.001)、肿瘤多发(调整后的比值比OR:1.927,95%CI:1.003~3.701,P=0.049)、颈部中央区淋巴结转移数>5个(调整后的比值比OR:2.630,95%CI:1.509~4.584,P=0.001)、颈侧区淋巴结转移数>5个(调整后的比值比OR:3.074,95%CI:1.649~5.730,P<0.001)与肿瘤复发相关。结论:肿瘤大小、肿瘤多发、颈部中央区淋巴结转移数>5个、颈侧区淋巴结转移数>5个是DTC外科切除联合131I及TSH抑制治疗后复发的独立危险因素。

Objective:To investigate the risk factors of recurrence after surgical resection of differentiated thyroid carcinoma combined with iodine-131 and TSH(Thyroid stimulating hormone)inhibition therapy.Methods:From January 2015 to April 2020,the clinical data of patients with structural recurrence and without recurrence were retrospectively collected after surgical treatment combined with iodine-131 and TSH inhibition therapy in the First Medical Center of PLA General Hospital.The general conditions of the two groups of patients were analyzed and the measurement data in line with the normal distribution was used for comparison between groups.For measurement data with non-normal distribution,the rank sum test was used for inter-group comparison.The Chi-square test was used for comparison between the counting data groups.Univariate and multivariate regression analyses were used to determine the risk factors associated with relapse.Results:The median follow-up period was 43 months(range 18-81 months)and 100 patients(10.5%)relapsed among the 955 patients.Univariate analysis showed that tumor size,tumor multiple,the number of lymph node metastases5 in the central region of the neck,and the number of lymph node metastases5 in the lateral region were significantly correlated with post-treatment recurrence(P0.001,P=0.018,P0.001,P0.001).Multivariate analysis showed that tumor size(adjusted odds ratio OR:1.496,95%CI:1.226-1.826,P0.001),tumor frequency(adjusted odds ratio OR:1.927,95%CI:1.003-3.701,P=0.049),the number of lymph node metastases in the central neck region5(adjusted odds ratio OR:2.630,95%CI:1.509-4.584,P=0.001)and the number of lymph node metastases in the lateral neck region5(adjusted odds ratio OR:3.074,95%CI:1.649-5.730,P=0.001)was associated with tumor recurrence.Conclusion:The study showed that tumor size,tumor multiple,the number of lymph node metastases in the central region of the neck5 and the number of lymph node metastases in the side of the neck 5 are independent risk factors for recurrence of differentiated thyroid cancer after surgical resection combined with iodine-131 and TSH inhibition therapy.