分化型甲状腺癌131I治疗后TgAb由阳转阴时间与临床转归的关系

Relationship between the disappearance time of TgAb and clinical outcomes in TgAb-positive differentiated thyroid cancer after 131I therapy

    摘要
  • 摘要:
    目的 探究131I治疗前甲状腺球蛋白抗体（TgAb）阳性（≥40 IU/ml）的分化型甲状腺癌（DTC）患者131I治疗后TgAb转阴时间与临床转归的关系，并分析影响的因素。
    方法 回顾性分析2014年1月至2019年1月在青岛大学附属医院行甲状腺全切术及131I治疗前TgAb阳性的126例DTC患者的临床资料，其中男性15例、女性111例，年龄11~74（42.1±11.5）岁。将患者按末次随访时的治疗反应分为疗效满意组和疗效不满意组。采用卡方检验、独立样本t检验、Mann-Whitney U检验分析2组间年龄、性别、原发灶最大径、肿瘤是否多灶、是否合并桥本甲状腺炎、术前甲状腺过氧化物酶抗体（TPOAb）水平、TgAb水平（术前及首次131I治疗前）、首次131I治疗后（1、6、12个月）TgAb水平的下降率、TgAb转阴时间、131I治疗总剂量、肿瘤分期、淋巴结分期、淋巴结转移率、首次131I治疗前复发危险分层的差异，对差异有统计学意义的变量进一步行Logistic回归分析，明确影响患者临床转归的独立危险因素。通过受试者工作特征（ROC）曲线确定预测患者临床转归的最佳临界值。
    结果 疗效满意组患者共109例，疗效不满意组患者共17例。2组间首次131I治疗后12个月TgAb水平下降率89.84%（82.81%，94.70%）对83.01%（74.99%，91.08%），Z=−2.168，P=0.030、TgAb转阴时间（25.06±17.96）个月对（45.41±22.11）个月，t=−4.206，P<0.001、131I治疗总剂量3 700（3 700，3 700） MBq对5 550（3 700，10 545） MBq，Z=−4.388，P<0.001的差异有统计学意义；而Logistic回归分析结果显示，TgAb转阴时间（OR=1.036，P=0.034）及131I治疗总剂量（OR=1.033，P=0.001）为预测临床转归的独立危险因素。ROC曲线分析结果显示，当TgAb转阴时间临界值为31.5个月（曲线下面积为0.766，95%CI：0.650~0.881，P<0.001）时，其预测临床转归的灵敏度及特异度最高，分别为78.00%和70.60%。
    结论 对于131I治疗前TgAb阳性的DTC患者，其TgAb转阴时间和131I治疗总剂量是预测患者临床转归的独立危险因素。TgAb在首次131I治疗后31.5个月内转阴的患者更易获得满意疗效，且疗效满意组患者所需的131I治疗总剂量比疗效不满意组更低。

     

    Abstract:
    Objective To explore the relationship between the disappearance time of thyroglobulin antibody (TgAb) and clinical outcomes in TgAb-positive (≥40 IU/ml) differentiated thyroid cancer (DTC) patients before 131I therapy and analyze the influencing factors.
    Methods A total of 126 TgAb-positive DTC patients who underwent total thyroidectomy and 131I therapy in the Affiliated Hospital of Qingdao University from January 2014 to January 2019 were retrospectively analyzed. The patients included 15 males and 111 females, aged 11−74(42.1±11.5) years old. The patients were divided into the excellent and non-excellent response group according to the clinical outcomes at the last follow-up. The chi-square, independent-samples t, and Mann-Whitney U tests were used to analyze the age, the gender, the maximum diameter of the primary tumor, whether the tumor was multifocal, whether the tumor is combined with Hashimoto's thyroiditis, the preoperative thyroid peroxidase antibody (TPOAb) level, the TgAb level (preoperative and before the first 131I therapy), the TgAb declined rate at 1/6/12 months after the first 131I therapy, the disappearance time of TgAb, the total 131I dosage, the tumor stage, the lymph node stage, the lymph node metastasis rate, and the recurrence risk stratification before the first 131I therapy. The differences between the two groups were further analyzed by Logistic regression analysis. The receiver operating characteristic (ROC) curve was used to determine the cut-off value for judging clinical outcomes.
    Results A total of 109 patients formed the excellent response group, and 17 patients formed the non-excellent response group. In the univariate analysis, the TgAb declined rate at 12 months after the first 131I therapy (89.84% (82.81%, 94.70%) vs. 83.01% (74.99%, 91.08%), Z=−2.168, P=0.030), the disappearance time of TgAb ((25.06±17.96) months vs. (45.41±22.11) months, t=−4.206, P<0.001), and the total 131I dosage (3 700(3 700, 3 700) MBq vs. 5 550(3 700, 10 545) MBq, Z=−4.388, P<0.001) showed statistically significant differences. The Logistic regression analysis showed that the disappearance time of TgAb (OR=1.036, P=0.034) and the total 131I dosage (OR=1.033, P=0.001) were the independent risk factors for predicting the clinical outcomes. ROC curve analysis showed that when the cut-off value of the disappearance time of TgAb was 31.5 months (area under the curve=0.766, 95%CI: 0.650−0.881, P<0.001), the sensitivity and specificity of predicting clinical outcomes were the highest, 78.00% and 70.60%, respectively.
    Conclusions For TgAb-positive DTC patients before 131I therapy, the disappearance time of TgAb and the total 131I dosage were the independent risk factors of the clinical outcomes. The patients were likely to obtain excellent response with the disappearance time of TgAb within 31.5 months after the first 131I therapy, and the total dosage of 131I required by the patients in the excellent response group was much lower than that required by the patients in the non-excellent response group.

     

    • HTML全文
    • 参考文献(15)
    • 相关文章
    • 施引文献
  • 资源附件(0)

/

返回文章
返回