血清学指标与甲状腺乳头状癌颈部淋巴结转移的相关性研究

Study on the relationship between serum markers and cervical lymph node metastasis in papillary thyroid carcinoma

目的探讨血清中甲状腺球蛋白(thyroglobulin,Tg)、甲状腺激素(thyroid stimulating hormone,TSH)水平、抗体水平与甲状腺乳头状癌(papillary thyroid cancer,PTC)发生颈部淋巴结转移(lymph node metastasis,LNM)的关系。方法回顾性收集2019年1月至2022年1月于重庆医科大学附属第一医院乳腺甲状腺外科就诊的1502例PTC患者为研究对象,男431例,女1071例;年龄<55岁1271例,≥55岁231例。根据颈部LNM情况,分为转移组927例与无转移组575例。所有患者术后经病理证实为PTC。将患者一般资料及术后病理报告中的指标与LNM分组进行单因素分析,将P<0.05的资料纳入回归分析,确定PTC患者颈部LNM的独立危险因素。根据抗甲状腺球蛋白抗体(antithyroglobulin antibody,TGAb)、甲状腺过氧化物酶抗体(thyroid peroxidase antibodies,TPOAb)、促甲状腺激素受体抗体(thyrotrophin receptor antibody,TRAb)的不同状态[(+)表示阳性;(-)表示阴性]将患者分为8种亚组。按照TGAb、TPOAb、TRAb的顺序,分别有以下8种状态:1(+++)、2(---)、3(++-)、4(+--)、5(+-+)、6(-+-)、7(-++)、8(--+)。比较两组中一般临床信息、Tg及TSH等方面的差异,构建Tg诊断PTC LNM的受试者工作特征(receiver operating characteristic curve,ROC)曲线,并采用回归分析探究血清学指标在PTC发生颈部LNM的诊断价值。结果本研究中,相比淋巴结未转移组,转移组中男308例(33.2%)、双侧PTC225例(24.3%)、血清Tg均值为(25.5±2.1)ng/mL,较非转移组中男123(21.4%),双侧PTC69例(12.0%),血清Tg均值(12.9±1.4)ng/mL,均显著增高(P<0.05)。二元Logistic回归分析结果显示,男(OR=1.57,P<0.001)、双侧PTC(OR=1.448,P<0.001)、非微小乳头状癌(>10 mm)(OR=1.745,P<0.001)、Tg水平增高(OR=1.007,P=0.002)为PTC患者颈部LNM的独立危险因素。Tg在评估颈部LNM中ROC曲线下面积为0.634[95%CI为(0.636,0.691),P<0.05]。而TSH状态在0.56~1.39(OR=0.375,P=0.013),1.40~2.29(OR=0.422,P=0.003),2.30~5.91(OR=0.466,P=0.004),≥5.91(OR=0.41,P=0.001)不是危险因素。结论男性、双侧甲状腺癌、非微小乳头状癌(>10 mm)、和术前血清Tg>29.8 ng/mL为PTC患者LNM的影响因素。

ObjectiveTo investigate the association between serum levels of thyroglobulin(Tg),thyroid stimulating hormone(TSH)and antibodies and lymph node metastasis(LNM)in papillary thyroid cancer(PTC).MethodsA total of 1502 patients with PTC who were admitted to the Department of Breast and Thyroid Surgery of the First Affiliated Hospital of Chongqing Medical University from Jan.2019 to Jan.2022 were retrospectively enrolled,including males(n=431),females(n=1071),aged<55 years(n=1271),and≥55 years old(n=231).All patients were pathologically confirmed to have PTC after surgery.Univariate analysis was performed on the general data of patients and the indexes in the postoperative pathology report and the LNM group,and the data of P<0.05 in the analysis were included in the regression analysis to determine the independent risk factors of cervical LNM in PTC patients.Patients were divided into 8 subgroups according to the different statuses of the three thyroid antibodies(TGAb,TPOAb,TRAb):[(+)indicates positive;(-)indicates negative].According to the order of TGAb,TPOAb,and TRAb,there are the following 8 states,1(+++);2(---);3(++-);4(+--);5(+-+);6(-+-);7(-++);8(--+).The differences in general clinical information,Tg and TSH between the two groups were compared,and the receiver operating characteristic curve(ROC)curve of Tg in the diagnosis of PTC lymph node metastasis was constructed,and regression analysis was used to explore the diagnostic value of serological indicators in the diagnosis of cervical LNM in PTC.ResultsIn this study,compared with the non-metastasis group,there were 308 males(33.2%)and 225 patients(24.3%)with bilateral PTC in metastasis group.The mean serum Tg value was(25.5±2.1)ng/mL and the TSH level was significantly increased(P<0.05),and the results of binary logistic regression analysis showed that males(OR=1.57,P<0.001),bilateral PTC(OR=1.448,P<0.001),non-papillary carcinoma(>10 mm)(OR=1.745,P<0.001)and increased Tg level(OR=1.007,P=0.002)were independent risk factors for cervical lymph node metastasis in PTC patients,and the area under the ROC curve of Tg in the evaluation of cervical lymph node metastasis was 0.634[95%CI(0.636,0.691),P<0.05],while the TSH status was 0.56-1.39(OR=0.375,P=0.013).1.40-2.29(OR=0.422,P=0.003);2.30-5.91(OR=0.466,P=0.004);≥5.91(OR=0.41,P=0.001)was not a risk factor.ConclusionMale sex,bilateral thyroid cancer,non-papillary carcinoma(>10 mm),and preoperative serum Tg>29.8 ng/mL are the influencing factors of LNM in PTC patients.