甲状腺癌根治术后血清微小RNA-335、146b-5p及675与生存情况的关系

Relationship between serum microRNA-335,146b-5p,675 and survival after radical thyroidectomy

目的探讨甲状腺癌根治术后血清微小核糖核酸335(miRNA-335)、微小核糖核酸146b-5p(miRNA146b-5p)及微小核糖核酸675(miRNA-675)与生存情况的关系。方法回顾性选取2017年3月至2019年3月在联勤保障部队第910医院行根治术治疗的84例甲状腺癌患者的临床资料。依据术后3年随访情况进行分组,存活组54例,死亡组30例。比较两组性别、年龄、体重指数、甲状腺影像报告和数据系统评分(TI-RADS)、临床分期、病理类型、手术方式、淋巴结转移情况、局部压迫感、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)、miRNA-335、miRNA146b-5p、miRNA-675以及术后治疗情况。通过受试者工作特征(ROC)曲线分析miRNA-335、miRNA146b-5p、miRNA-675预测甲状腺癌根治术后死亡价值。采用多因素Logistic回归分析甲状腺癌根治术后死亡的危险因素。结果84例患者3年内存活54例,存活率为64.29%,死亡30例,死亡率为35.71%;两组年龄、性别、体重指数、肿瘤直径、TI-RADS评分、临床分期、手术方式、临床分期、局部压迫感、TSH、FT3、FT4水平比较,差异均无统计学意义(P>0.05),死亡组未分化癌、存在淋巴结转移、术后未进行规范化治疗人数占比高于存活组,miRNA146b-5p表达高于存活组,miRNA-335、miRNA-675表达低于存活组,差异均有统计学意义(P<0.05)。经ROC分析证实血清微小RNA-335、146b-5p、675均可用于预测甲状腺癌根治术后死亡,曲线下面积分别为0.926、0.878、0.922,有较好的预测价值(P<0.05)。经多因素Logistic回归分析证实,未分化癌、淋巴结转移、术后未进行规范治疗、miRNA-335≤5.135、miRNA146b-5p≥4.775、miRNA-675≤4.850均为甲状腺癌根治术后死亡的危险因素(P<0.05)。结论影响甲状腺癌根治术后生存情况的因素较多,如病理类型、淋巴结转移,术后未进行规范化治疗以及miRNA-335、miRNA146b-5p、miRNA-675表达水平等,当患者符合miRNA-335≤5.135、miRNA146b-5p≥4.775、miRNA-675≤4.850因素时,应引起临床重视,及时给予干预治疗。

Objective To investigate the relationship between serum miRNA-335,miRNA146b-5p and miRNA-675 and survival after radical thyroidectomy.Methods The clinical data of 84 patients with thyroid cancer who underwent radical surgery in JCSF 910th Hospital from March 2017 to March 2019 were retrospectively analyzed.The patients were divided into survival group(54 cases)and death group(30 cases)according to the 3-year follow-up after operation.Sex,age,body mass index,thyroid imaging report and data system score(TI-RADS),clinical stage,pathological type,surgical method,lymph node metastasis,local compression,thyroid stimulating hormone(TSH),free triiodothyronine(FT3),free tetraiodothyronine(FT4),miRNA-335,miRNA146b-5p,miRNA-675,and postoperative treatment were compared between the two groups.Receiver operating characteristic(ROC)analysis of miRNA-335,miRNA146b-5p,miRNA-675 was used to predict the value of death after radical thyroidectomy.Multivariate logistic regression was used to analyze the risk factors of death after radical thyroidectomy.Results Among 84 patients,54 survived within 3 years,the survival rate was 64.29%,30 died,and the mortality rate was 35.71%.There was no statistically significant difference in age,gender,body mass index,tumor diameter,TI-RADS score,clinical staging,surgical method,clinical staging,local compression,TSH,FT3,and FT4 levels between the two groups(P>0.05),the proportion of death group with undifferentiated cancer,lymph node metastasis and no standardized treatment after operation was higher than that of survival group,the expression of miRNA146b-5p was higher than that of survival group,and the expressions of miRNA-335 and miRNA-675 were lower than those of survival group,the differences were statistically significant(P<0.05).ROC analysis confirmed that serum microRNA-335,146b-5p and 675 could be used to predict the death after radical resection of thyroid cancer.The area under the curve was 0.926,0.878 and 0.922 respectively,all P<0.05;Multivariate logistic regression analysis confirmed that undifferentiated cancer,lymph node metastasis,lack of standardized treatment after surgery,miRNA-335≤5.135,miRNA146b-5p≥4.775,miRNA-675≤4.850 were all risk factors for death after radical resection of thyroid cancer(P<0.05).Conclusion There are many factors that affect the survival of patients with thyroid cancer after radical surgery,such as pathological type,lymph node metastasis,lack of standardized treatment after surgery,and miRNA-335,miRNA146b-5p,miRNA-675,etc.When patients meet the factors of miRNA-335≤5.135,miRNA146b-5p≥4.775,miRNA-675≤4.850,clinical attention should be paid and timely intervention should be given.