分化型甲状腺癌^(131)I治疗前刺激性Tg与最佳治疗反应的关系

Relationship between preablative stimulated thyroglobulin and the excellent response in differentiated thyroid carcinoma

背景与目的:初始治疗(手术+^(131)I+TSH抑制)后的疗效反应对动态评估患者的复发风险至关重要。本研究旨在探讨^(131)I治疗前刺激性甲状腺球蛋白(preablative-stimulated thyroglobulin,ps-Tg)对最佳治疗反应的预测价值。方法:纳入中位随访74.5个月的分化型甲状腺癌(differentiated thyroid carcinoma,DTC)患者136例,根据治疗反应评估体系将其治疗效果分为4组:最佳治疗反应(excellent response,ER)(86例)、疗效不确切(indeterminate response,IDR)(18例)、血清学反应欠佳(biochemical incomplete response,BIR)(4例)和影像学反应欠佳(structural incomplete response,SIR)(28例)。采用χ~2检验、Fisher精确检验和Kruskal-Wallis秩和检验比较4组患者的基本临床特征,建立ps-Tg及肿瘤大小与ER关系的受试者工作特征(receiver operating characteristic,ROC)曲线获得最佳界值点,对影响ER的因素进行多因素分析,进一步采用Kaplan-Meier曲线评估ps-Tg及肿瘤大小发生非ER的累积风险,使用log-rank法对差异进行统计学分析。结果:4组间ps-Tg水平、肿瘤大小、腺外侵犯、多灶性、淋巴结分期以及TNM分期差异有统计学意义(P<0.05),而性别和年龄差异无统计学意义(P>0.05)。ps-Tg以及肿瘤大小与ER关系的ROC曲线下面积分别为0.865和0.666,当ps-Tg以9.05 ng/mL为界值预测ER时,灵敏度和特异度较高(分别为83.7%和80.0%),肿瘤直径以1.05 cm为界值点时的灵敏度和特异度分别为53.5%和72.0%。多因素分析显示ps-Tg和肿瘤大小可以作为预测ER的独立因素(OR=20.571,P=0.015;OR=3.291,P=0.008)。随着肿瘤直径的增大,ps-Tg≥9.05组患者的非ER风险明显高于ps-Tg<9.05组(P=0.000 3)。结论:ps-Tg(界值点为9.05 ng/mL)可用于预测本组患者最佳治疗反应,其与肿瘤大小结合可以更全面地预测初始治疗后的疗效。

Background and purpose:The response after initial treatment[surgery+131I+thyroid-stimulating hormone(TSH)suppression]is critical for the dynamic assessment of the risk of recurrence in patients with differentiated thyroid cancer(DTC).This study aimed to investigate the potential value of preablative stimulated thyroglobulin(ps-Tg)of DTC patients in predicting the therapeutic response.Methods:Patients with a median follow-up of 74.5 months(136 patients)were divided into 4 groups according to the therapeutic response evaluation system:excellent response(ER)(86 patients),indeterminate response(IDR)(18 patients),biochemical incomplete response(BIR)(4 patients),and structural incomplete response(SIR)(28 patients).Theχ2 test,Fisher’s exact test and Kruskal-Wallis test were used to evaluate the differences in basic clinicopathological features among the 4 groups.The receiver operating characteristic(ROC)curve was analyzed to evaluate the clinical value of ps-Tg and tumor size for predicting ER and the optimal cut-off point respectively.Multivariate analysis was used to quantify the independent factors of ER.The cumulative risk of non-excellent response curves according to ps-Tg and tumor size were constructed with the Kaplan-Meier method,and the log-rank test was used to compare these curves.Results:Significant differences in ps-Tg level,tumor size and extrathyroidal invasion could be observed among the 4 groups(P<0.05),while there was no significant difference in gender,age and cervical lymph node metastasis(P>0.05).The areas under the ROC curves of ps-Tg and tumor size for predicting ER were 0.865 and 0.666,respectively.A cut-off value of ps-Tg was obtained at 9.05 ng/mL,with high sensitivity and specificity of 83.7%and 80.0%respectively,and 1.05cm of tumor diameter was set as the cut-off value with relatively low sensitivity and specificity of 53.5%and 72.0%,respectively.Multivariate analysis showed that ps-Tg and tumor size could be used as independent predictors of ER(OR=20.571,P=0.015;OR=3.291,P=0.008).With the increase of diameter,the non-ER risk of patients with ps-Tg≥9.05 ng/mL was significantly higher than that of the group with ps-Tg<9.05 ng/mL(P=0.000 3).Conclusion:ps-Tg(with a cut-off value of 9.05 ng/mL)could predict the ER in this cohort,and its combination with tumor size might better predict the non-ER response to initial treatment.