摘要
目的 探讨超声引导下细针穿刺联合肿瘤标志物对甲状腺癌术后复发转移的诊断价值.方法 选取我院行甲状腺癌根治术后可疑复发转移的分化型甲状腺癌(DTC)患者 98 例,均行超声引导下细针穿刺细胞学检查(US-FNAC)及血清肿瘤标志物[甲状腺球蛋白(Tg)、癌胚抗原(CEA)、糖类抗原 125(CA125)、糖类抗原 199(CA199)、细胞角蛋白 19片段(CYFRA21-1)]检测,比较复发转移组和未复发转移组临床资料、US-FNAC检查结果及血清肿瘤标志物水平,分析术后复发转移的影响因素,通过ROC曲线、DCA评价相关因素诊断术后复发转移的价值和临床效用.结果 复发转移组病灶多发(χ2=10.599)、肿瘤直径≥2 cm(χ2=8.369)、临床分期Ⅲ～Ⅳ期(χ2=7.134)、术前淋巴结转移(χ2=6.132)、被膜侵犯(χ2=9.779)、Tg阳性占比(χ2=32.067)及血清 CEA(t=12.386)、CA125(t=10.730)、CA199(t=11.506)、CYFRA21-1(t=16.236)水平均较未复发转移组高(P<0.05);复发转移组US-FNAC阳性率 90.38%(47/52)高于未复发转移组 26.09%(12/46)(χ2=42.117,P<0.001);Tg阳性、血清CEA、CA125、CA199、CYFRA21-1 水平与DTC患者病灶数目、肿瘤直径、临床分期、术前淋巴结转移、被膜侵犯均相关(P<0.05);Tg阳性、血清CEA、CA125、CA199、CYFRA21-1、US-FNAC阳性水平均为术后复发转移的独立危险因素(OR=5.183、3.800、3.228、3.496、4.451、6.974,P<0.05);Tg阳性、血清 CEA、CA125、CA199、CYFRA21-1、US-FNAC阳性水平诊断术后复发转移的AUC分别为 0.781、0.808、0.738、0.763、0.827、0.821,联合诊断的AUC为 0.903,大于各指标单独诊断的AUC(Z=0.215、0.194、2.871、2.354、1.859、0.190,P<0.05),绘制DCA分析显示各指标联合在术后复发转移诊断方面具有良好临床效用.结论 US-FNAC联合血清Tg、CEA、CA125、CA199、CYFRA21-1 可用于DTC术后转移复发诊断中,为临床早期诊断提供参考依据,以针对性展开后续治疗.
Abstract
Objective To explore the diagnostic value of ultrasound-guided fine needle aspiration combined with tumor mark-ers for postoperative recurrence and metastasis of thyroid cancer.Methods Ninety-eight patients with Differentiated differenti-ated thyroid cancer(DTC)with suspected relapses and metastases after radical thyroid carcinoma combined with 131I treatment were selected.Ultrasound-guided fine needle aspiration cytology(US-FNAC)and serum tumor markers(thyroglobulin(Tg),carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),carbohydrate antigen 199(CA199),cytokeratin 19 frag-ment(CYFRA21-1)were conducted.The results of pathological examination were used as the"gold standard"to compare the clinical data,US-FNAC test results and serum tumor marker levels between the relapsed metastasis group and the non-relapsed metastasis group.The factors related to postoperative recurrence and metastasis were screened out by Lasso regression model,and the influence of the above factors on postoperative recurrence and metastasis was analyzed by Logistic regression.The value and clinical effectiveness of related factors in the diagnosis of postoperative recurrence and metastasis were evaluated by ROC curve and DCA.Results The multiple lesions(χ2=10.599),tumor diameter≥2 cm(χ2=8.369),clinical stage Ⅲ～Ⅳ(χ2=7.134),preoperative lymph node metastasis(χ2=6.132),membrane invasion(χ2=9.779),Tg positive proportion(χ2=32.067),and serum CEA(t=12.386),CA125(t=10.730),CA199(t=11.506),and CYFRA21-1(t=16.236)levels in the relapsed metasta-sis group were higher than those in the non-relapsed metastasis group(P＜0.05).The positive rate of US-FNAC in relapsed me-tastasis group was 90.38%,higher than that in non-relapsed metastasis group 26.09%(χ2=42.117,P<0.001).Tg positive,se-rum CEA,CA125,CA199,and CYFRA21-1 levels were independent risk factors for postoperative recurrence and metastasis(OR=5.183,3.800,3.228,3.496,4.451,6.974,P<0.05);the AUC for postoperative recurrence and metastasis diagnosed with Tg positive,serum CEA,CA125,CA199,and CYFRA21-1 levels were 0.781,0.808,0.738,0.763,0.827,and 0.821,respectively,and the AUC for combined diagnosis was 0.903,which was greater than the AUC diagnosed separately for each in-dicator.Conclusion US-FNAC combined serum Tg,CEA,CA125,CA199 and CYFRA21-1 can be used in the diagnosis of postoperative metastasis and recurrence of DTC,providing reference for early clinical diagnosis and targeted follow-up treat-ment.
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