γ-谷氨酰环化转移酶对临床判断淋巴结阴性甲状腺微小乳头状癌中央区淋巴结转移的预测价值

The predictive value of γ-glutamyl cyclotransferase for central lymph node metastasis in clinically node-negative papillary thyroid microcarcinoma

目的:探讨γ-谷氨酰环化转移酶(GGCT)预测临床判断淋巴结阴性(cN0)期甲状腺微小乳头状癌(PTMC)中央区淋巴结转移(CLNM)的临床价值。方法:回顾性分析华中科技大学同济医学院附属同济医院甲状腺乳腺外科2021年8月至2022年3月收治的108例cN0期PTMC患者的临床及病理资料,通过酶联免疫吸附实验(ELISA)检测病灶细针穿刺(FNA)洗脱液GGCT的表达含量,应用受试者工作曲线(ROC)曲线评估GGCT预测CLNM的临床价值,构建单因素和多因素回归模型,分析与CLNM相关的危险因素。结果:伴有CLNM的样本GGCT含量明显高于不伴有CLNM的样本[(2.09±0.53)ng/ml比(1.29±0.24)ng/ml,t=3.34,P<0.05];ROC曲线表明GGCT预测CLNM的敏感度为76.09%,特异度为85.48%,最佳临界值为1.60 ng/ml;单因素分析结果显示,年龄[<55岁69例,无CLNM比伴有CNLM=40∶29,≥55岁39例,无CLNM比伴有CNLM=22∶17,χ^(2)=0.02,P>0.05]、性别[女80例,无CLNM比伴有CNLM=49∶31,男28例,无CLNM比伴有CNLM=13∶15,χ^(2)=1.86,P>0.05]、多灶性情况[多灶32例,无CLNM比伴有CNLM=15∶17,单灶76例,无CLNM比伴有CNLM=47∶29,χ^(2)=2.06,P>0.05]以及是否合并有桥本甲状腺炎[合并33例,无CLNM比伴有CNLM=23∶10,未合并75例,无CLNM比伴有CNLM=39∶36,χ^(2)=2.94,P>0.05],与CLNM无关,而肿瘤直径[>5 mm 54例,无CLNM比伴有CNLM=20∶34,≤5 mm 54例,无CLNM比伴有CNLM=42∶12,χ^(2)=18.33,P<0.05]、是否伴有甲状腺外侵犯[伴有20例,无CLNM比伴有CNLM=6∶14,未伴有88例,无CLNM比伴有CNLM=56∶32,χ^(2)=7.54,P<0.05]以及术前FNA洗脱液GGCT含量[>1.60 ng/ml 44例,无CLNM比伴有CNLM=9∶35,≤1.60 ng/ml 64例,无CLNM比伴有CNLM=53∶11,χ^(2)=41.47,P<0.05]与CLNM相关。多因素Logistic分析结果表明,术前FNA洗脱液GGCT含量高于1.60 ng/ml[比值比(OR)=6.99,95%可信区间(CI):2.77~18.20,P<0.05]和肿瘤直径>5 mm(OR=5.67,95%CI:1.75~18.35,P<0.05)为cN0期PTMC发生CLNM的独立危险因素。结论:术前检测FNA洗脱液中GGCT含量可作为预测cN0期PTMC是否发生CLNM的有效手段。

Objective To investigate the clinical significance ofγ-glutamyl cyclotransferase(GGCT)in predicting central lymph node metastasis(CLNM)in clinically node-negative(cN0)papillary thyroid microcarcinoma(PTMC).Methods The clinical and pathological data of 108 patients with PTMC at cN0 stage,who were admitted to the Department of Thyroid and Breast Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from August 2021 to March 2022,were retrospectively analyzed.The expression of GGCT in the eluate obtained from fine needle aspiration(FNA)was detected using enzyme-linked immunosorbent assay(ELISA).Receiver operating characteristic(ROC)curve analysis was performed to assess the predictive value of GGCT for CLNM.Univariate and multivariate regression models were constructed to identify risk factors associated with CLNM.Results The GGCT content of samples with CLNM was significantly higher than that of samples without CLNM[(2.09±0.53)ng/ml vs.(1.29±0.24)ng/ml,t=3.34,P<0.05].The ROC curve demonstrated that GGCT exhibits a sensitivity of 76.09%and specificity of 85.48%for predicting CLNM,with a best cut-off value of 1.60 ng/ml.Univariate analysis revealed no significant association between age[<55 years old(69 cases),without CLNM vs.with CLNM=40∶29,≥55 years old(39 cases),without CLNM vs.with CLNM=22∶17,χ^(2)=0.02,P>0.05],gender[female(80 cases),without CLNM vs.with CLNM=49∶31,male(28 cases),without CLNM vs.with CLNM=13∶15,χ^(2)=1.86,P>0.05],multifocal lesions[multifocal(32 cases),without CLNM vs.with CLNM=15∶17,unifocal(76 cases),without CLNM vs.with CLNM=47∶29,χ^(2)=2.06,P>0.05]or Hashimoto’s thyroiditis[with(33 cases),without CLNM vs.with CLNM=23∶10,without(75 cases),without CLNM vs.with CLNM=39∶36,χ^(2)=2.94,P>0.05]and CLNM,while tumor diameter[>5 mm(54 cases),without CLNM vs.with CLNM=20∶34,≤5 mm(54 cases),without CLNM vs.with CLNM=42∶12,χ^(2)=18.33,P<0.05],extrathyroidal extension[with(20 cases),without CLNM vs.with CLNM=6∶14,without(88 cases),without CLNM vs.with CLNM=56∶32,χ^(2)=7.54,P<0.05]and GGCT expression in FNA eluate[>1.60 ng/ml(44 cases),without CLNM vs.with CLNM=9∶35,≤1.60 ng/ml(64 cases),without CLNM vs.with CLNM=53∶11,χ^(2)=41.47,P<0.05]were associated with CLNM.Multivariate Logistic regression analysis showed that the GGCT content of FNA eluate exceeding 1.60ng/ml[odds ratio(OR)=6.99,95%confidence interval(CI):2.77-18.20,P<0.05],along with a tumor diameter larger than 5 mm(OR=5.67,95%CI:1.75-18.35,P<0.05),remains as independent risk factors for cN0 PTMC with CLNM.Conclusion The detection of GGCT in FNA eluate represents a promising approach for predicting the occurrence of CLNM in cN0 PTMC.