刺激性甲状腺球蛋白和淋巴结转移数与甲状腺乳头状癌疗效的关系

Relationship between stimulatory thyroglobulin,lymph node metastasis number,and therapeutic efficacy in papillary thyroid cancer patients

目的探讨^(131)I治疗前刺激性血清甲状腺球蛋白(psTg)和淋巴结转移数(NLNM)以及其他临床指标与甲状腺乳头状癌(PTC)患者疗效的关系。方法本研究为回顾性队列研究。连续性收集2017-01-01-2020-01-01济宁医学院附属医院甲状腺外科1072例PTC患者的临床资料。患者男262例,女810例;年龄18~79岁,中位年龄47岁。患者均于甲状腺手术后行^(131)I治疗,随访观察患者^(131)I的治疗效果。研究性别、年龄、原发肿瘤大小、T分类和N分类、TNM分期、psTg水平、NLNM和淋巴结转移比率(LNR)等临床特征是否为疗效不满意(NER)的影响因素。采用Cox回归模型进行各因素与疗效关系的分析。采用受试者工作特征曲线(ROC)确定最佳截止值,并计算ROC曲线下面积、灵敏度及特异度,根据psTg的截止值进一步分析疗效不满意的影响因素。结果在单因素分析中,桥本甲状腺炎(HR=0.583,P=0.003)、psTg(HR=1.003,P<0.001)、NLNM>5个(HR=1.801,P<0.001)、男性(HR=1.250,P=0.028)、癌灶长径>1.0 cm(HR=1.470,P=0.001)、^(131)I治疗前甲状腺球蛋白抗体(pTgAb,HR=0.999,P=0.019)与NER相关。在多因素分析中,NLNM>5个(HR=1.743,P=0.001)、psTg(HR=1.002,P<0.001)和pTgAb(HR=0.999,P=0.041)与NER有关联。当患者psTg<7.15μg/L时,只有NLNM>5(HR=2.548,P<0.001)是PTC患者NER的独立风险因素。结论PTC患者NLNM>5个、psTg以及pTgAb与较差的^(131)I疗效有关联,sTg是PTC患者NER最主要的影响因素,当患者psTg水平较低(<7.15μg/L)时,结合NLNM可以更加准确地评价PTC患者的疗效。

Objective To explore the relationship between stimulatory serum thyroglobulin(psTg),number of lymph node metastases(NLNM),other clinical indicators before ^(131)I treatment and the efficacy of patients with papillary thyroid cancer(PTC).Methods This study was a retrospective cohort study.Clinical data of 1072patients with PTC in the Department of Thyroid Surgery,Affiliated Hospital of Jining Medical College from January 1,2017to January 1,2020were continuously collected.There were 262males and 810females.Age ranged from 18to 79years,with a median age of 47years.The patients were all treated with ^(131)I after thyroid surgery.The patients were followed up to observe the therapeutic effect of ^(131)I.To study whether clinical characteristics such as sex,age,primary tumor size,T classification and N classification,TNM stage,psTg level,NLNM and lymph node metastasis ratio(LNR)were influencing factors of unsatisfactory efficacy(NER).Cox regression model was used to analyze the relationship between various factors and efficacy.The receiver operating characteristic curve(ROC)was used to determine the optimal cutoff value,and the area under the ROC curve,sensitivity and specificity were calculated,and the influencing factors of unsatisfactory efficacy were further analyzed based on the cutoff value of psTg.Results In univariate analysis,Hashimoto's thyroiditis(HR=0.583,P=0.003),psTg(HR=1.003,P<0.001),NLNM>5(HR=1.801,P<0.001),male(HR=1.250,P=0.028),maximumdiameter of cancer lesion>1.0cm(HR=1.470,P=0.001),and pre-treatment thyroglobulin antibody(pTgAb,HR=0.999,P=0.019)were related to NER.In multivariate analysis,NLNM>5(HR=1.743,P=0.001),psTg(HR=1.002,P<0.001)and pTgAb(HR=0.999,P=0.041)were associated with NER.When patients'psTg<7.15μg/L,only NLNM>5(HR=2.548,P<0.001)was an independent risk factor for NER in PTC patients.Conclusions NLNM>5,psTg and pTgAb in PTC patients are related to poor ^(131)I efficacy in PTC patients.sTg is the most important factor affecting the dissatisfaction with the efficacy in PTC patients.When the patient's psTg level is low(<7.15μg/L),combined with NLNM can more accurately evaluate the ^(131)I efficacy in PTC patients.