目的 探讨131I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1 072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131I治疗,随访观察患者131I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)、131I 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＜7.15 μg/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131I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(＜7.15 μg/L)时,结合NLNM可以更加准确地评价PTC患者的疗效.
Relationship between stimulatory thyroglobulin,lymph node metastasis number,and therapeutic efficacy in papillary thyroid cancer patients
Objective To explore the relationship between stimulatory serum thyroglobulin(psTg),number of lymph node metastases(NLNM),other clinical indicators before 131I treatment and the efficacy of patients with papillary thyroid canc-er(PTC).Methods This study was a retrospective cohort study.Clinical data of 1 072 patients with PTC in the Depart-ment of Thyroid Surgery,Affiliated Hospital of Jining Medical College from January 1,2017 to January 1,2020 were continuously collected.There were 262 males and 810 females.Age ranged from 18 to 79 years,with a median age of 47 years.The patients were all treated with 131I after thyroid surgery.The patients were followed up to observe the ther-apeutic effect of 131I.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 un-satisfactory 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＞1.0 cm(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＜7.15 μg/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 131I 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(＜7.15 μg/L),combined with NLNM can more accurately evaluate the 131I efficacy in PTC patients.
papillary thyroid carcinoma131I treatmentresponse to treatmentnumber of lymph node metastasisthyroglobulin
NETL
NSTL
万方数据
