超声联合血清Tg在甲状腺癌患者术前N分期及手术治疗效果评估中的价值研究

The value of ultrasonography combined with serum thyroglobulin levels in preoperative N staging and therapeutic effect evaluation in patients with thyroid cancer

目的探讨超声联合血清甲状腺蛋白(Tg)在甲状腺癌患者术前N分期及手术治疗效果评估中的临床价值。方法回顾性分析2016年1月至2021年12月在解放军联勤保障部队第九〇三医院接受甲状腺全切术治疗的甲状腺癌患者125例的临床资料,根据病理结果分为N0、N1a、N1b期,采用一致性检验分析超声检查与病理结果诊断的一致性;比较N0期与N1期组血清学指标;采用多因素logistic回归分析对抗甲状腺过氧化物(TPOAb)、Tg与淋巴结转移的相关性进行分析;采用受试者工作特征(ROC)曲线分析血清Tg、超声检查以及超声检查联合血清Tg对淋巴结转移的诊断价值。结果125例患者中,51例病理结果为N1期,其中N1a期36例,N1b期15例;74例病理结果为N0期。超声检查结果显示N0期96例,N1a期7例,N1b期22例。超声检查甲状腺癌患者术前N分期与病理结果分期中等一致(Kappa值=0.44,P<0.001)。N1期组血清游离三碘甲状腺原氨酸(FT3)、Tg比N0期组高(P<0.001),血清TPOAb比N0期组低(P=0.017)。因变量为淋巴结转移,自变量为FT3、TPOAb、Tg,进行多因素logistic回归分析筛选,得出Tg与淋巴结转移有相关性(OR=1.02,P<0.001);ROC曲线结果显示,血清Tg、超声诊断淋巴结转移的曲线下面积(AUC)分别为0.67、0.65,比联合检测的0.76低(P<0.001)。结论采用超声联合血清Tg对甲状腺癌术前患者N分期进行判定具有一定的临床价值,且超声联合血清Tg对淋巴结转移的诊断价值高于单纯采用超声检查,因此临床在对术前淋巴结转移进行判定时可参考超声以及血清Tg的检测结果,以指导手术,并对手术治疗效果进行评估。

Objective To investigate the clinical value of ultrasonography combined with serum thyroglobulin(Tg)levels in preoperative N staging and therapeutic effect evaluation in patients with thyroid cancer.Methods A retrospective analysis was conducted on the clinical data of 125 patients with thyroid cancer who underwent total thyroidectomy at The 903 Hospital of PLA Joint Logistics Support Force between January 2016 and December 2021.Based on the pathological results,the patients were divided into stages N0,N1a,and N1b.Consistency testing was performed to assess the consistency between ultrasonographic and pathological findings.The serological markers were compared between stage N0 and stage N1.A multivariate logistic regression analysis was conducted to investigate the correlation between antithyroid peroxidase antibodies(TPOAb)and Tg and lymph node metastasis.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of serum Tg,ultrasonography,and the combination of serum Tg with ultrasonography for lymph node metastasis.Results Among the 125 patients,51 cases were diagnosed with stage N1,including 36 cases of stage N1a and 15 cases of stage N1b.The pathological examination confirmed stage N0 in 74 cases.Ultrasonography results showed stage N0 in 96 cases,stage N1a in 7 cases,and stage N1b in 22 cases.The preoperative N staging of thyroid cancer patients by ultrasonography was moderately consistent with the pathological staging(Kappa=0.44,P<0.001).Serum free triiodothyronine and Tg levels were higher in stage N1 compared with stage N0(P<0.001),while serum TPOAb levels were lower in stage N1 than in stage N0(P=0.017).Multivariate logistic regression analysis was performed with lymph node metastasis as the dependent variable and the factors FT3,TPOAb,and Tg levels as independent variables.The analysis revealed that Tg was associated with lymph node metastasis(OR=1.02,P<0.001).The ROC curve analysis showed that the area under the ROC curve for serum Tg level and ultrasonography for the diagnosis of lymph node metastasis were 0.67 and 0.65,respectively,which were significantly lower than the area under the curve(0.76)for the combined detection(P<0.001).Conclusion The combined utilization of ultrasonography and serum Tg levels in the preoperative staging of thyroid cancer patients holds distinct clinical relevance.Notably,this combined approach offers a more precise diagnosis of lymph node metastasis compared with ultrasonography alone.Consequently,when making clinical judgments regarding preoperative lymph node metastasis,it is advisable to consider the results of both ultrasonography and serum Tg testing to facilitate surgical planning and evaluate surgical outcomes.