中危甲状腺乳头状癌病人131I治疗后肿瘤复发因素分析

doi:10.16139/j.1007-9610.2023.06.09

摘要/Abstract

摘要：

目的: 分析中危甲状腺乳头状癌(papillary thyroid carcinoma, PTC)病人¹³¹I治疗后复发因素。方法: 纳入2018年1月至2020年5月本院254例中危PTC病人¹³¹I治疗后复发情况，通过卡方检验及多因素分析探索¹³¹I治疗后复发的主要因素。结果: 34例（13.4%）中危病人¹³¹I治疗后复发。原发灶大小、淋巴结转移分期及术后¹³¹I治疗前刺激性甲状腺球蛋白（pre-ablation stimulated thyroglobulin, psTg）与肿瘤复发相关。通过受试者工作特征(receiver operating characteristic, ROC)曲线分析，psTg 为25.6 μg/L时，是预测PTC复发最佳截断值。进一步多因素分析发现淋巴结转移分期与psTg水平是预测PTC复发的独立因素。联合这两个指标，当淋巴结分期N1b且psTg ≥25.6 μg/L，¹³¹I治疗后肿瘤复发率为58.3%；当淋巴结分期N1a且psTg <25.6 μg/L时，¹³¹I治疗后肿瘤复发率仅2.3%。结论: 淋巴结转移分期与psTg水平是PTC复发的重要指标，联合这两个指标有助于预测¹³¹I治疗后肿瘤复发。

关键词: 甲状腺乳头状癌, 中危, 放射性碘治疗, 肿瘤复发, 甲状腺球蛋白

Abstract:

Objective To analyze the recurrence factors of the patients with intermediate risk papillary thyroid carcinoma (PTC) after radioactive iodine treatment (RAIT). Methods A total of 254 intermediate risk PTC patients after RAIT from January 2018 to May 2020 in our hospital were enrolled into this study. Chi square test and multivariate analysis were applied to analyze the main recurrence factors after RAIT. Results Thirty four (13.4%) patients with intermediate risk PTC relapsed after RAIT. The primary tumor size, lymph node metastasis staging, and pre-ablation stimulated thyroglobulin (psTg) were associated with tumor recurrence. According to the receiver operating characteristic （ROC） curve, psTg 25.6 μg/L was the best cutoff value for predicting recurrence. Further multivariate analysis revealed that lymph node metastasis staging and psTg levels were independent factors of predicting PTC recurrence. When the patients with N1b and psTg≥25.6 μg/L, the incidence of tumor recurrence after RAIT was 58.3%. While the patients with N1a and psTg<25.6 μg/L, the incidengce of tumor recurrence was only 2.3%. Conclusions Lymph node metastasis staging and psTg level are the important indicators of PTC recurrence, and combining these two indicators can help predict tumor recurrence after RAIT.

Key words: Papillary thyroid carcinoma, Intermediate risk, Radioactive iodine treatment, Tumor recurrence, Thyroglobulin

中图分类号:

R736.1

汤玲琳, 李莉, 来益, 刘建军, 周翔. 中危甲状腺乳头状癌病人¹³¹I治疗后肿瘤复发因素分析[J]. 外科理论与实践, 2023, 28(06): 536-539.

TANG Linglin, LI Li, LAI Yi, LIU Jianjun, ZHOU Xiang. Analysis of tumor recurrence factors of the patients with intermediate risk papillary thyroid carcinoma after radioactive iodine treatment[J]. Journal of Surgery Concepts & Practice, 2023, 28(06): 536-539.

图/表 3

参考文献 14

[1]	HUANG J, NGAI C H, DENG Y, et al. Incidence and mortality of thyroid cancer in 50 countries: a joinpoint regression analysis of global trends[J]. Endocrine, 2023, 80(2):355-365. doi: 10.1007/s12020-022-03274-7 pmid: 36607509
[2]	HAY I D, THOMPSON G B, GRANT C S, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940-1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients[J]. World J Surg, 2002, 26(8):879-885. doi: 10.1007/s00268-002-6612-1 pmid: 12016468
[3]	MAZZAFERRI E L, JHIANG S M. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer[J]. Am J Med, 1994, 97(5):418-428. doi: 10.1016/0002-9343(94)90321-2 pmid: 7977430
[4]	HAUGEN B R, ALEXANDER E K, BIBLE K C, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer[J]. Thyroid, 2016, 26(1):1-133. doi: 10.1089/thy.2015.0020 URL
[5]	HUNG M L, WU J X, LI N, et al. Association of radioactive iodine administration after reoperation with outcomes among patients with recurrent or persistent papillary thyroid cancer[J]. JAMA Surg, 2018, 153(12):1098-1104. doi: 10.1001/jamasurg.2018.2659 pmid: 30140908
[6]	RUEL E, THOMAS S, DINAN M, et al. Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer[J]. J Clin Endocrinol Metab, 2015, 100(4):1529-1536. doi: 10.1210/jc.2014-4332 pmid: 25642591
[7]	TIAN T, QI Z, HUANG S, et al. Radioactive iodine therapy decreases the recurrence of intermediate-risk PTC with low thyroglobulin levels[J]. J Clin Endocrinol Metab, 2023, 108(8):2033-2041. doi: 10.1210/clinem/dgad045 URL
[8]	GARG A, CHOPRA S, BALLAL S, et al. Differentiated thyroid cancer in patients over 60 years of age at presentation: a retrospective study of 438 patients[J]. J Geriatr Oncol, 2015, 6(1):29-37. doi: 10.1016/j.jgo.2014.09.182 pmid: 25287965
[9]	LIU L, ZHANG X, TIAN T, et al. Prognostic value of pre-ablation stimulated thyroglobulin in children and adolescents with differentiated thyroid cancer[J]. Thyroid, 2020, 30(7):1017-1024. doi: 10.1089/thy.2019.0585 pmid: 31964278
[10]	KWON S Y, LEE S W, KONG E J, et al. Clinicopathologic risk factors of radioactive iodine therapy based on response assessment in patients with differentiated thyroid cancer: a multicenter retrospective cohort study[J]. Eur J Nucl Med Mol Imaging, 2020, 47(3):561-571. doi: 10.1007/s00259-019-04634-8
[11]	SIGNORE A, LAURI C, DI PAOLO A, et al. Predictive role of serum thyroglobulin after surgery and before radioactive iodine therapy in patients with thyroid carcinoma[J]. Cancers (Basel), 2023, 15(11):2976. doi: 10.3390/cancers15112976 URL
[12]	ROSARIO P W, MOURAO G F, SIMAN T L, et al. A low postoperative nonstimulated serum thyroglobulin level excludes the presence of persistent disease in low-risk papillary thyroid cancer patients: implication for radioiodine indication[J]. Clin Endocrinol(Oxf), 2015, 83(6):957-961. doi: 10.1111/cen.2015.83.issue-6 URL
[13]	LI S, REN C, GONG Y, et al. The role of thyroglobulin in preoperative and postoperative evaluation of patients with differentiated thyroid cancer[J]. Front Endocrinol (Lau-sanne), 2022, 13:872527.
[14]	PICCARDO A, ARECCO F, PUNTONI M, et al. Focus on high-risk DTC patients: high postoperative serum thyroglobulin level is a strong predictor of disease persistence and is associated to progression-free survival and overall survival[J]. Clin Nucl Med, 2013, 38(1):18-24. doi: 10.1097/RLU.0b013e318266d4d8 pmid: 23242039

Characteristics	n	Excellent response	Recurrent disease	χ² value	P value
Number of patients	254	220	34
Gender
Male	108	89	19	2.87	0.09
Female	146	131	15
Age
≥55 year	58	53	5	1.47	0.23
<55 year	196	167	29
Residual thyroid
≤1 g	212	186	26	1.39	0.24
>1 g	42	34	8
Primary tumor size（long diameter）
≥4 cm	37	28	9	4.47	0.04
<4 cm	217	192	25
Number of primary tumor
1	87	74	13	0.28	0.60
>1	167	146	21
Lymph node metastasis
N1a	86	80	6	4.61	0.03
N1b	168	140	28
BRAF mutation^a)
-	93	79	14	0.96	0.33
+	82	65	17

Parameters	OR	95%CI	P value
psTg	24.8	9.7-63.5	<0.01
N staging	6.8	2.2-20.9	<0.01

[1]	蔡晓雨, 张瑞国, 胡玉敬, 王任飞, 边艳珠. 乳头状甲状腺微小癌不宜作为术后¹³¹I治疗的决策依据[J]. 外科理论与实践, 2023, 28(06): 529-535.
[2]	廖振宇, 赵起悟, 匡洁, 刘卓然, 孙寒星, 王越, 邱伟华, 陈曦, 严佶祺. 高细胞亚型甲状腺乳头状癌的侵袭性组织病理学特征研究[J]. 外科理论与实践, 2023, 28(06): 524-528.
[3]	况李君, 陶玲玲, 詹维伟, 李伟伟, 樊金芳, 周伟. 细针穿刺洗脱液Tg测定阳性相关的甲状腺淋巴结超声特征分析[J]. 诊断学理论与实践, 2023, 22(03): 255-260.
[4]	孔韦奇, 何俊, 杨成广, 刘微薇, 徐英杰. 嗜铬细胞瘤合并甲状腺乳头状癌（附1例报告）[J]. 外科理论与实践, 2023, 28(02): 162-165.
[5]	颜海波, 夏中平, 陈善, 姜琳, 韩春. 甲状腺乳头状癌Delphian淋巴结转移的危险因素[J]. 外科理论与实践, 2022, 27(05): 453-457.
[6]	王文涵, 夏蜀珺, 詹维伟. 长链非编码RNA ENST00000489676在超声评估甲状腺乳头状癌颈部淋巴结转移中的应用[J]. 诊断学理论与实践, 2022, 21(04): 514-519.
[7]	徐琛莹, 李嫣然, 倪晓枫, 徐上妍, 林青. 超声预测老年甲状腺乳头状癌患者颈部淋巴结转移的效能及相关超声征象分析[J]. 诊断学理论与实践, 2022, 21(03): 343-348.
[8]	刘荣耀, 李祥翠, 王丽娜, 陈海珍. 甲状腺乳头状癌颈部淋巴结转移的危险因素分析[J]. 外科理论与实践, 2022, 27(01): 76-79.
[9]	谷巍, 侯丽萍, 李晓龙, 耿建林. 硒酵母联合维生素D对不同年龄分层的桥本甲状腺炎患者甲状腺相关抗体水平的影响[J]. 内科理论与实践, 2021, 16(06): 392-396.
[10]	唐娟, 刘志艳. 第4版WHO分化型甲状腺癌病理分类及其进展[J]. 外科理论与实践, 2021, 26(06): 504-509.
[11]	刘威, 王聪, 王正林, 艾志龙. 单侧甲状腺乳头状癌Delphian淋巴结转移的发生率及其临床意义[J]. 外科理论与实践, 2021, 26(05): 445-448.
[12]	况李君, 陶玲玲, 詹维伟, 李伟伟, 樊金芳, 周伟. 负压细针抽吸和毛细抽吸活检法穿刺洗脱液中甲状腺球蛋白测定在甲状腺乳头状癌淋巴结转移中的诊断价值比较[J]. 诊断学理论与实践, 2021, 20(04): 367-371.
[13]	刘威, 王聪, 薛安慰, 赵骏杰, 王正林. 单侧cN₀甲状腺癌病人中央区淋巴结转移特性及其预防性清扫[J]. 外科理论与实践, 2021, 26(02): 159-162.
[14]	杨一娴, 倪仲馨, 夏蜀珺, 周伟, 詹维伟. 多灶性与单灶性甲状腺乳头状癌的临床病理特征及超声表现的比较[J]. 诊断学理论与实践, 2021, 20(02): 168-172.
[15]	王星, 汪蓉晖, 张桂萍, 董屹婕, 周伟, 詹维伟. 10 388个甲状腺结节行超声引导下细针抽吸活检的甲状腺癌各亚型诊断准确率的10年研究[J]. 诊断学理论与实践, 2020, 19(04): 359-363.

中危甲状腺乳头状癌病人¹³¹I治疗后肿瘤复发因素分析

Analysis of tumor recurrence factors of the patients with intermediate risk papillary thyroid carcinoma after radioactive iodine treatment

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 3

参考文献 14

相关文章 15

编辑推荐

Metrics

本文评价