复发/持续性分化型甲状腺癌二次手术患者3年DFS现状及影响因素分析

目的 研究复发/持续性分化型甲状腺癌二次手术患者3年无疾病生存期（DFS）及其影响因素。方法 纳入本研究所2015年4月至2017年4月160例复发/持续性分化型甲状腺癌二次手术患者作为研究对象，术后随访记录3年DFS。采用Logistic多因素分析法分析影响患者预后的独立影响因素。结果 160例患者二次手术后3年肿瘤进展28例，3年DFS为82.50%，28例肿瘤进展患者为观察组，132例为对照组。Logistic多因素分析结果显示肿瘤直径和分期是复发持续性分化型甲状腺患者二次手术后无进展生存的高危因素（OR=3.079，1.867；P＜0.05），淋巴结清除是无进展生存的保护因素（OR=0.548，P＜0.05）。受试者工作曲线（ROC）曲线分析结果显示肿瘤直径判断预后的曲线下面积（AUC）为0.816（S.E.=0.052，95%CL=0.714-0.918，P=0.000），灵敏度为0.714，特异度为0.764，最佳截断值为5.100cm。肿瘤分期和淋巴结清扫情况判断预后的AUC分别为0.754和0.693（S.E.=0.0067，0.081；95%CL=0.624-0.885；0.534-0.852，P=0.003，0.024），灵敏度分别为0.857和0.643，特异度分别为0.652和0.742。结论 复发持续性分化型甲状腺癌二次手术患者3年DFS与肿瘤直径、分期及淋巴结清扫情况密切相关，临床应引起重视。

The analysis of 3-year DFS status and influence factors in patients with recurrent/persistent differentiated thyroid cancer of secondary surgery

Objective To study the 3-year disease free survival (DFS) status and influence factors in patients with recurrent/persistent differentiated thyroid cancer of secondary surgery.Methods 160 patients with recurrent/persistent differentiated thyroid cancer from April 2015 to April 2017 were included as the research objects,the 3-year DFS was recorded.The Logistic multivariate analysis was used to analyze the independent factors influence the prognosis of patients.Results There were 28 patients had tumor progression of the secondary operation in 160 patients, and the 3 year disease free survival was 82.50%.There were 28 patients with tumor progression in the observation group,132 cases were in the control group.The results of logistic multivariate analysis showed that the tumor diameter and stage were the high risk factors for progression free survival of patients with recurrent and persistent differentiated thyroid after the second operation (OR=3.079,1.867;P<0.05), and the lymph node clearance was the protective factor for progression free survival (OR=0.548，P<0.05).The results of receiver operating characteristic curve (ROC) curve analysis showed that the area under the curve (AUC) of tumor diameter to predict the prognosis was 0.816 (S.E.=0.052,95%CL=0.714-0.918,P=0.000),the sensitivity was 0.714, the specificity was 0.764, and the best cutoff value was 5.100cm.The AUC of tumor stage and lymph node dissection to predict the prognosis were 0.754 and 0.693, respectively (S.E.=0.067,0.081;95%CL=0.624-0.885;0.534-0.852;P=0.003,0.024).The sensitivity were 0.857 and 0.643, and the specificity were 0.652 and 0.742, respectively.Conclusion The 3 DFS of patients with recurrent and persistent differentiated thyroid cancer after reoperation is closely related to tumor diameter, stage and lymph node dissection.It should be paid attention in clinical. prophylactic central lymph node dissection