甲状腺球蛋白对甲状腺癌术后碘131治疗预后的预测价值研究
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摘要
目的:探讨甲状腺球蛋白(Tg)对甲状腺癌术后碘131治疗预后的预测价值。方法:选取2015年5月至2017年5月山东省聊城市第二人民医院收治的甲状腺癌患者110例,所有患者在甲状腺癌术后均接受碘131治疗,随访时间为12个月。通过放射性碘全身扫描(WBS)评估患者术后碘131的疗效,根据WBS分级标准分成WBS阳性组(Ⅱ～Ⅳ级)、WBS阴性组(Ⅰ级)。所有患者每隔6个月测定1次血清Tg水平,比较两组临床特征,采用受试者工作特征(ROC)曲线模型分析血清Tg水平对患者术后碘131疗效的预测价值,采用多因素Logistic分析明确WBS阳性的独立危险因素。结果:通过12个月随访发现,WBS阳性61例(46.56%),WBS阴性49例(37.40%)。经ROC曲线模型提示,血清Tg水平对预测碘131治疗预后的曲线下面积为0.787,最佳临界值为1.430μg/L,敏感度、特异度分别为0.860、0.717。经多因素Logistic回归分析显示,双侧原发病灶、肿瘤分期晚、多发病灶及血清Tg水平>1.430μg/L是甲状腺癌术后WBS阳性的独立危险因素(P<0.05)。结论:血清Tg水平对甲状腺癌术后碘131治疗预后有一定预测价值,血清Tg水平过高是碘131治疗后WBS阳性的独立危险因素,临床可将其作为评估甲状腺癌术后碘131治疗效果的重要指标。
Objective:To investigate the predictive value of thyroglobulin(Tg)for the prognosis of iodine131 therapy in thyroid cancer.Methods:A total of 110 thyroid cancer patients in our hospital from May 2015 to May 2017 were selected.All patients received iodine 131 treatment after surgery and were followed up for12 months.Whole Body Scan(WBS)was used to evaluate the postoperative efficacy of iodine 131.Based on WBS classification standard,the patients were divided into WBS positive group(Ⅱ-Ⅳ)and WBS negative group(Ⅰ).Serum Tg level was measured every 6 months.The clinical features between groups were compared.The value of estimating serum Tg concentration in the prognosis of iodine 131 therapy was analyzed by receiver operating characteristic(ROC)curve.Multivariate logistic regression analysis was used to identify independent risk factors for positive WBC.Results:After 12 months of follow-up,61 cases(46.56%)of positive WBS and 49 cases(37.40%)of negative WBS were found.The area under the ROC curve of the serum Tg level for predicting the prognosis of iodine 131 therapy was 0.787 with a cutoff value of 1.430μg/L,a sensitivity of 0.860 and a specificity of 0.717.Multivariate logistic regression analysis showed that bilateral primary lesions,late tumor stage,multiple lesions and serum Tg level>1.430 g/L were independent risk factors for positive WBS after thyroid cancer surgery(P<0.05).Conclusion:Serum Tg level was valuable for predicting the prognosis of iodine 131 treatment in thyroid cancer.High serum Tg level was an independent risk factor for positive WBS after iodine 131 treatment.It might be an important marker for the evaluation of iodine 131 therapeutic effect.
Objective:To investigate the predictive value of thyroglobulin(Tg)for the prognosis of iodine131 therapy in thyroid cancer.Methods:A total of 110 thyroid cancer patients in our hospital from May 2015 to May 2017 were selected.All patients received iodine 131 treatment after surgery and were followed up for12 months.Whole Body Scan(WBS)was used to evaluate the postoperative efficacy of iodine 131.Based on WBS classification standard,the patients were divided into WBS positive group(Ⅱ-Ⅳ)and WBS negative group(Ⅰ).Serum Tg level was measured every 6 months.The clinical features between groups were compared.The value of estimating serum Tg concentration in the prognosis of iodine 131 therapy was analyzed by receiver operating characteristic(ROC)curve.Multivariate logistic regression analysis was used to identify independent risk factors for positive WBC.Results:After 12 months of follow-up,61 cases(46.56%)of positive WBS and 49 cases(37.40%)of negative WBS were found.The area under the ROC curve of the serum Tg level for predicting the prognosis of iodine 131 therapy was 0.787 with a cutoff value of 1.430μg/L,a sensitivity of 0.860 and a specificity of 0.717.Multivariate logistic regression analysis showed that bilateral primary lesions,late tumor stage,multiple lesions and serum Tg level>1.430 g/L were independent risk factors for positive WBS after thyroid cancer surgery(P<0.05).Conclusion:Serum Tg level was valuable for predicting the prognosis of iodine 131 treatment in thyroid cancer.High serum Tg level was an independent risk factor for positive WBS after iodine 131 treatment.It might be an important marker for the evaluation of iodine 131 therapeutic effect.
引文
[1]黄海燕,刘细荣,李小虎,等.Survivin蛋白在甲状腺癌组织中的表达及其临床意义[J].广西医科大学学报,2017,34(5):733-735.
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[10]KREJBJERG A,BJERGVED L,BLOW PEDERSEN I,et al.Serum thyroglobulin as a biomarker of iodine deficiency in adult populations[J].Clinical Endocrinology,2016,85(3):475-482.
[11]徐景竹,王兴华,吴琼,等.颈部超声、甲状腺球蛋白诊断复发分化型甲状腺癌[J].中国癌症杂志,2016,26(1):97-101.
[12]徐金锴.Tg变化对甲状腺癌转移性淋巴结检测特异性分析[J].现代医学,2017,45(8):1076-1079.
[13]李欢,杜小梅,冯真,等.不同剂量131I清甲治疗对分化型甲状腺癌唾液腺功能和生活质量的影响[J].解放军医药杂志,2017,29(10):26-29.
[14]SALARI B,REN Y,KAMANI D,et al.Revision neural monitored surgery for recurrent thyroid cancer:Safety and thyroglobulin response[J].Laryngoscope,2016,126(4):1020-1025.
[15]SIRAJ A K,MASOODI T,BU R,et al.Genomicprofiling of thyroid cancer reveals a role for thyroglobulin in metastasis[J].American Journal of Human Genetics,2016,98(6):1170-1180.
[2] BA L L S,DESANTIS C,AHMEDIN J D,et al.Changes in thyroid cancer incidence,post-2009 American Thyroid Association guidelines[J].Laryngoscope,2017,127(10):2437-2441.
[3]吴长华,韩大力,王亮,等.精确放疗治疗甲状腺癌的研究进展[J].临床肿瘤学杂志,2016,21(7):665-668.
[4]赵靖,王荣福.血清Tg水平在分化型甲状腺癌诊疗进程中的临床价值[J].肿瘤学杂志,2016,22(11):880-884.
[5]梁坤,李诗运,戴儒奇,等.放射性碘-131治疗分化型甲状腺癌转移灶的疗效及其影响因素[J].临床内科杂志,2017,34(5):323-325.
[6] NIXON I J,KUK D,WREESMANN V,et al.Defining avalid age cutoff in staging of well-differentiated thyroid cancer[J].Annals of Surgical Oncology,2016,23(2):410-415.
[7]中华医学会内分泌学分会.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床,2012,39(17):1249-1272.
[8] ZILIOLI V,PELI A,PANAROTTO M B,et al.Differentiated thyroid carcinoma:incremental diagnostic value of 131ISPECT/CT over planar whole body scan after radioiodine therapy[J].Endocrine,2016,56(3):551-559.
[9] MOMESSO D P,TUTTLE R M.Response toletter:What is the role of serum thyroglobulin measurement in patients with differentiated thyroid cancer treated without radioactive iodine?[J].Journal of Clinical Endocrinology&Metabolism,2017,102(6):2115-2116.
[10]KREJBJERG A,BJERGVED L,BLOW PEDERSEN I,et al.Serum thyroglobulin as a biomarker of iodine deficiency in adult populations[J].Clinical Endocrinology,2016,85(3):475-482.
[11]徐景竹,王兴华,吴琼,等.颈部超声、甲状腺球蛋白诊断复发分化型甲状腺癌[J].中国癌症杂志,2016,26(1):97-101.
[12]徐金锴.Tg变化对甲状腺癌转移性淋巴结检测特异性分析[J].现代医学,2017,45(8):1076-1079.
[13]李欢,杜小梅,冯真,等.不同剂量131I清甲治疗对分化型甲状腺癌唾液腺功能和生活质量的影响[J].解放军医药杂志,2017,29(10):26-29.
[14]SALARI B,REN Y,KAMANI D,et al.Revision neural monitored surgery for recurrent thyroid cancer:Safety and thyroglobulin response[J].Laryngoscope,2016,126(4):1020-1025.
[15]SIRAJ A K,MASOODI T,BU R,et al.Genomicprofiling of thyroid cancer reveals a role for thyroglobulin in metastasis[J].American Journal of Human Genetics,2016,98(6):1170-1180.