PTC术后~(131)I清甲后刺激性Tg水平对预后评估的价值分析
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摘要
目的探讨刺激性甲状腺球蛋白(sTg)对乳头状甲状腺癌(PTC)转移灶的预测价值。方法随访603例经甲状腺全切术行~(131)I清除残留甲状腺组织(清甲)后6个月的PTC患者,将患者分为M0组(无转移)、M1组(颈部淋巴结转移N1a)、M2组(颈部淋巴结转移N1b)、M3组(肺转移)、M4组(骨及其它脏器转移),比较5组间sTg的差异,通过M1组、 M2组、M3组+M4组与M0组的受试者工作特征(ROC)曲线下面积(AUC)及最佳诊断界值点(DCP)评估sTg对远处转移的预测价值。结果 M0组sTg为0.34(0.04,2.79)ng/ml、M1组sTg为8.40(4.00,18.88)ng/ml、M2组sTg为39.22(22.48,62.29)ng/ml、M3组sTg为375.09(158.64,464.00)ng/ml、M4组sTg为313.29(117.63,464.00)ng/ml,除M3组与M4组之间差异无统计学意义外(P>0.05),其余各组差异均有统计学意义(P均<0.05)。M1组sTg ROC的AUC为0.858,DCP为1.8 ng/ml(灵敏度0.725、特异度0.896);M2组sTg ROC的AUC为0.986,DCP为12.18 ng/ml(灵敏度0.958、特异度0.947);M3组+M4组sTg ROC的AUC为0.999,DCP为32.45 ng/ml(灵敏度1.000、特异度0.976)。结论 sTg对PTC术后~(131)I清甲后是否转移以及转移程度有较高的诊断及预测价值。
Objective To evaluate the value of stimulated thyroglobulin(sTg) level in predicting the metastasis of papillary thyroid cancer(PTC). Methods A total of 603 PTC patients who had undergone total thyroidectomy and ~(131) I therapy for 6 months were enrolled and divided into the M0(non-metastasis), M1(cervical lymph node metastasis N1 a), M2(cervical lymph node metastasis N1 b), M3(lung metastasis) and M4(metastasis of bone and other organs) groups. The sTg levels were statistically compared among five groups. The value of sTg level in predicting the distant metastasis of PTC was assessed by the area under the curve of ROC and diagnostic critical point(DCP) in the M1, M2, M3 +M4 and M0 groups, respectively. Results The sTg level was 0.34(0.04,2.79) ng/ml in the M0 group, 8.40(4.00,18.88) ng/ml in the M1 group,(22.48,62.29) ng/ml in the M2 group, 375.09(158.64,464.00) ng/ml in the M3 group and 313.29(117.63,464.00) ng/ml in the M4 group, respectively. No statistical significance was noted between the M3 and M4 groups(P>0.05), whereas statistical significance was observed among other groups(all P<0.05). In the M1 group, the the area under the curve of ROC was 0.858 and the DCP was 1.8 ng/ml with a sensitivity of 0.725 and a specificity of 0.896, 0.986 and 12.18 ng/ml(sensitivity: 0.958, specificity: 0.947) in the M2 group, 0.999 and 32.45 ng/ml(sensitivity: 1.000, specificity: 0.976) in the M3+M4 group, respectively. Conclusion The sTg level possesses relatively high diagnostic and predictive value for the risk and degree of PTC metastasis after ~(131) I therapy.
Objective To evaluate the value of stimulated thyroglobulin(sTg) level in predicting the metastasis of papillary thyroid cancer(PTC). Methods A total of 603 PTC patients who had undergone total thyroidectomy and ~(131) I therapy for 6 months were enrolled and divided into the M0(non-metastasis), M1(cervical lymph node metastasis N1 a), M2(cervical lymph node metastasis N1 b), M3(lung metastasis) and M4(metastasis of bone and other organs) groups. The sTg levels were statistically compared among five groups. The value of sTg level in predicting the distant metastasis of PTC was assessed by the area under the curve of ROC and diagnostic critical point(DCP) in the M1, M2, M3 +M4 and M0 groups, respectively. Results The sTg level was 0.34(0.04,2.79) ng/ml in the M0 group, 8.40(4.00,18.88) ng/ml in the M1 group,(22.48,62.29) ng/ml in the M2 group, 375.09(158.64,464.00) ng/ml in the M3 group and 313.29(117.63,464.00) ng/ml in the M4 group, respectively. No statistical significance was noted between the M3 and M4 groups(P>0.05), whereas statistical significance was observed among other groups(all P<0.05). In the M1 group, the the area under the curve of ROC was 0.858 and the DCP was 1.8 ng/ml with a sensitivity of 0.725 and a specificity of 0.896, 0.986 and 12.18 ng/ml(sensitivity: 0.958, specificity: 0.947) in the M2 group, 0.999 and 32.45 ng/ml(sensitivity: 1.000, specificity: 0.976) in the M3+M4 group, respectively. Conclusion The sTg level possesses relatively high diagnostic and predictive value for the risk and degree of PTC metastasis after ~(131) I therapy.
引文
[1]凌煜玮,赵菁,韩婧,李开富,康骅.桥本甲状腺炎对甲状腺微小乳头状癌的影响及相关因素分析.新医学,2018,49(7):511-516.
[2]武新宇,高永举,尤伟,闫新慧,崔静,王鹏. 131I治疗甲状腺乳头状癌颈部淋巴结转移的疗效观察及影响因素分析.中华核医学与分子影像杂志, 2015,35(2):112-115.
[3]HaugenBR,AlexanderEK,BibleKC,DohertyGM,Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM,Schlumberger M,Schuff KG,Sherman SI,Sosa JA,Steward DL,Tuttle RM, Wartofsky L.2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer.Thyroid,2016,26(1):1-133.
[4]Locsei Z, Szabolcs I, Rácz K, Kovács GL, Horváth D, Toldy E.Serum thyoglobuliun antibody levels within or near to the reference range may interfere with thyroglobulin measurement.Biochem Med(Zagreb),2012, 22(3):365-370.
[5]Giovanella L. Highly sensitive thyroglobulin measurements in differentiated thyroid carcinoma management. Clin Chem Lab Med, 2008, 46(8):1067-1073.
[6]李田军,林岩松,梁军,李小毅,邱李恒,王莎莎,陈永辉,康增寿,李方. 131I治疗前刺激性Tg对乳头状甲状腺癌远处转移的预测价值.中华核医学与分子影像杂志,2012,32(3):189-191.
[7]Piccardo A, Arecco F, Puntoni M, Foppiani L, Cabria M,Corvisieri S, Arlandini A, Altrinetti V, Bandelloni R, Orlandi F. Focus on high-risk DTC patients:high postoperative serum throglobulin Level is a strong predictor of disease persistence and is associated to progres-sion-free survival and overall survival.Clin Nucl Med, 2013,38(1):18-24.
[8]李夏黎,武新宇,闫新慧,王鹏,汤敏敏,崔静,李晓飞,徐俊玲,高永举.激发态甲状腺球蛋白评估分化型甲状腺癌131I清甲治疗后转移的临床价值.中华核医学与分子影像杂志,2017, 37(3):153-156.
[9]Suh I, Vriens MR, Guerrero MA, Griffin A, Shen WT, Duh QY, Clark OH, Kebebew E. Serum thyruglobulin is a poor diagnostic biomarker of malignancy in follicular and Hurthle—cell neoplasm s of the thyroid. Am J Surg,2010,200(1):41-46.
[2]武新宇,高永举,尤伟,闫新慧,崔静,王鹏. 131I治疗甲状腺乳头状癌颈部淋巴结转移的疗效观察及影响因素分析.中华核医学与分子影像杂志, 2015,35(2):112-115.
[3]HaugenBR,AlexanderEK,BibleKC,DohertyGM,Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM,Schlumberger M,Schuff KG,Sherman SI,Sosa JA,Steward DL,Tuttle RM, Wartofsky L.2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer.Thyroid,2016,26(1):1-133.
[4]Locsei Z, Szabolcs I, Rácz K, Kovács GL, Horváth D, Toldy E.Serum thyoglobuliun antibody levels within or near to the reference range may interfere with thyroglobulin measurement.Biochem Med(Zagreb),2012, 22(3):365-370.
[5]Giovanella L. Highly sensitive thyroglobulin measurements in differentiated thyroid carcinoma management. Clin Chem Lab Med, 2008, 46(8):1067-1073.
[6]李田军,林岩松,梁军,李小毅,邱李恒,王莎莎,陈永辉,康增寿,李方. 131I治疗前刺激性Tg对乳头状甲状腺癌远处转移的预测价值.中华核医学与分子影像杂志,2012,32(3):189-191.
[7]Piccardo A, Arecco F, Puntoni M, Foppiani L, Cabria M,Corvisieri S, Arlandini A, Altrinetti V, Bandelloni R, Orlandi F. Focus on high-risk DTC patients:high postoperative serum throglobulin Level is a strong predictor of disease persistence and is associated to progres-sion-free survival and overall survival.Clin Nucl Med, 2013,38(1):18-24.
[8]李夏黎,武新宇,闫新慧,王鹏,汤敏敏,崔静,李晓飞,徐俊玲,高永举.激发态甲状腺球蛋白评估分化型甲状腺癌131I清甲治疗后转移的临床价值.中华核医学与分子影像杂志,2017, 37(3):153-156.
[9]Suh I, Vriens MR, Guerrero MA, Griffin A, Shen WT, Duh QY, Clark OH, Kebebew E. Serum thyruglobulin is a poor diagnostic biomarker of malignancy in follicular and Hurthle—cell neoplasm s of the thyroid. Am J Surg,2010,200(1):41-46.