分化型甲状腺癌术后首次血清刺激性Tg水平对远处转移的预测价值

目的 探讨分化型甲状腺癌（DTC）患者术后首次血清预先刺激性甲状腺球蛋白（ps-Tg）水平对远处转移的预测价值。 方法 收集2016年8月至2017年8月首次行131I治疗的113例DTC患者的临床资料，其中男性32例、女性81例，年龄15~68（44.85±12.01）岁。将患者分为无远处转移（M0）组和远处转移（M1）组。所有患者在未服或停服左旋甲状腺素4周后，行甲状腺功能与抗体水平等检测，行131I治疗后全身显像（Rx-WBS）和局部SPECT/CT断层融合显像。采用χ2检验、独立样本t检验和Mann-Whitney秩和检验对比2组患者的基本资料；采用Mann-Whitney秩和检验比较2组之间ps-Tg水平的差异；非参数法建立ps-Tg水平的受试者工作特征（ROC）曲线，获得最佳诊断界值点（DCP）。 结果 M0组（85例）与M1组（28例）的病理类型、颈部淋巴转移情况及131I治疗剂量均存在差异，且差异有统计学意义（χ2=12.588、12.588、12.581，P=0.003、0.003、0.002）；而性别、年龄、肿瘤分期、手术至首次检测ps-Tg的时间、促甲状腺激素和甲状腺球蛋白抗体水平的差异均无统计学意义。2组患者ps-Tg水平的M（P25~P75）分别为1.95（0.70~6.98） ng/mL和95.05（6.98~278.47） ng/mL，且差异有统计学意义（U=417.5，P=0.000）。ps-Tg水平ROC曲线下面积为0.825（95%CI:0.713~0.936），灵敏度、特异度和准确率分别为71.4%、91.8% 和86.7%，DCP为28.80 ng/mL。 结论 DTC术后首次血清ps-Tg水平对预测DTC远处转移有重要价值。

Predictive value of postoperative initial stimulated thyroglobulin level on distant metastasis of differentiated thyroid carcinoma

Objective To investigate the predictive value of postoperative initial stimulated thyroglobulin(ps-Tg) level on the distant metastasis of differentiated thyroid carcinoma(DTC). Methods A total of 113 patients who suffered from DTC and underwent first radioactive iodine(RAI) therapy from August 2016 to August 2017 were identified. Of these patients, 32 were males and 81 were females. Their ages ranged from 15 years to 68 years (44.85±12.01 years). The patients were classified into a non-distant metastasis(M0) group and a distant metastasis(M1) group. The biochemical parameters of thyroid function and thyroid antibodies were evaluated after 4 weeks of levothyroxine withdrawal. After RAI therapy, whole body imaging and local SPECT/CT were performed. The basic data of the two groups were compared via a chi-square test, Student's t test, and a Mann-Whitney rank-sum test. ps-Tg values between M0 and M1 were also compared via the Mann-Whitney rank-sum test. An receiver operating characteristic(ROC) curve was drawn and analyzed to evaluate the predictive value of ps-Tg, and a diagnostic critical point(DCP) was obtained. Results Differences in pathological type, cervical lymph node metastasis, and RAI dose were observed between M0(85 cases) and M1(28 cases) (χ2=12.588, 12.588, 12.581; P=0.003, 0.003, 0.002). No significant differences were found in gender, age, tumor stage, and time from surgery to the first measurement of Tg, TSH, and TgAb between the two groups. The mean values M(P25~P75) of ps-Tg levels in the two groups were 1.95(0.70–6.98) and 95.05 (6.98–278.47) ng/mL. A significant difference was present between the two groups(U=417.5, P=0.000). The area under the ROC curve of ps-Tg levels was 0.825(95%CI: 0.713–0.936), with a sensitivity of 71.4%, a specificity of 91.8%, and an accuracy of 86.7%. The cut-off value of DCP was 28.80 ng/mL. Conclusion The initial ps-Tg level is a meaningful indicator for predicting the distant metastases of DTC.