血清25-羟维生素D水平对DTC患者首次131I治疗最佳治疗反应的预测价值

Predictive value of serum 25-hydroxyvitamin D levels on the excellent response to initial 131I treatment in patients with differentiated thyroid cancer

    摘要
  • 摘要:
    目的 探讨血清25-羟维生素D水平对分化型甲状腺癌（DTC）患者首次131I治疗最佳治疗反应（ER）的预测价值。
    方法 回顾性分析2021年4月至2022年５月在中山大学附属第七医院核医学科接受首次131I治疗的105例DTC患者的临床资料，其中男性38例、女性67例，年龄（38.9±10.6）岁；另选取该院健康体检者73名作为正常对照组，其中男性37名、女性36名，年龄（41.6±10.5）岁。按照血清25-羟维生素D水平将DTC患者分为2组：血清25-羟维生素D水平<30 ng/ml为维生素D不足或缺乏组；血清25-羟维生素D水平≥30 ng/ml为维生素D充足组。所有患者在131I治疗6个月后进行疗效评估：ER、生化疗效不佳（BIR）、结构性疗效不佳（SIR）和疗效不确定（IDR）。根据疗效评估结果将患者分为疗效满意（ER）组和疗效不佳（非ER）组，将BIR、SIR、IDR归为非ER组。采用独立样本t检验（方差齐）、Mann-Whitney U检验、χ2检验及Fisher确切概率检验比较2组的一般临床资料；采用多因素Logistic回归分析影响131I治疗效果的因素，采用受试者工作特征曲线评估血清25-羟维生素D水平对131I治疗后ER的预测价值。
    结果 DTC患者的血清25-羟维生素D水平低于正常对照组（23.19±6.64） ng/ml 对 （26.57±9.48） ng/ml，且差异有统计学意义（t=2.634，P=0.01）。ER组患者61例（58.10%，61/105），非ER组患者44例（41.90%，44/105）。2组DTC患者在性别（χ2=0.001，P=0.975）、年龄（t=−0.468，P=0.641）、131I治疗时机（χ2=0.011，P=0.915）、T分期（χ2=2.436，P=0.119）、有无淋巴结转移（Fisher确切概率检验，P=0.14）、肿瘤最大径（Z=1.537，P=0.124）、有无腺外侵犯（χ2=1.028，P=0.311）的差异均无统计学意义，血清25-羟维生素D水平（t=4.588，P<0.01）的差异有统计学意义。多因素Logistic回归分析结果显示，血清25-羟维生素D水平是ER的独立影响因素（OR=0.849，95%CI：0.781~0.923，P<0.001）。血清25-羟维生素D水平预测131I治疗ER的最佳临界值为20.69 ng/ml，曲线下面积为0.736，其灵敏度和特异度分别为77.00%和63.60%。
    结论 血清25-羟维生素D水平对DTC患者首次131I治疗ER有一定的预测价值。

     

    Abstract:
    Objective  To explore the predictive value of serum 25-hydroxyvitamin D on the excellent response (ER) to initial 131I treatment in patients with differentiated thyroid cancer (DTC).
    Methods  A retrospective analysis was performed with 105 DTC patients (38 males, 67 females; aged (38.9±10.6) years) subjected to initial 131I treatment from April 2021 to May 2022 in the Department of Nuclear Medicine, the Seventh Affiliated Hospital of Sun Yat-sen University. A total of 73 healthy subjects (37 males, 36 females; aged (41.6±10.5) years) who underwent physical examinations in the hospital were selected as the normal control group. All DTC patients were divided into two groups according to serum 25-hydroxyvitamin D levels. The group with serum 25-hydroxyvitamin D levels<30 ng/ml was considered as the vitamin D deficiency or insufficiency group. The group with serum 25-hydroxyvitamin D levels≥30 ng/ml was considered as the vitamin D sufficiency group. According to the treatment response, at least 6 months after 131I treatment, patients were divided into ER, biochemical incomplete response (BIR), structural incomplete response (SIR), and indeterminate response (IDR). Patients were divided into excellent response (ER) group and non-ER group based on the efficacy evaluation results, the last three groups were further combined into a non-ER group. Independent sample t test (equal variance), Mann–Whitney U test, χ2 test, and Fisher′s exact test were used to compare the general clinical dates between the two groups. Multivariate Logistic regression analysis was performed to analyze the factors influencing 131I treatment reactions. A receiver operating characteristic curve was established to evaluate the predictive value of serum 25-hydroxyvitamin D levels for ER after 131I treatment.
    Results  The serum 25-hydroxyvitamin D levels in the DTC group were significantly lower than those in the normal control group ((23.19±6.64) ng/ml vs. (26.57±9.48) ng/ml; t=2.634, P=0.01). The ER group had 61 patients (58.10%, 61/105), whereas the non-ER group had 44 patients (41.90%, 44/105). No significant differences were found between the two groups in gender (χ2=0.001, P=0.975), age (t=−0.468, P=0.641), timing of 131I therapy (χ2=0.011, P=0.915), T stage (χ2=2.436, P=0.119), lymph-node metastasis (Fisher′s exact test, P=0.14), maximum size of tumor (Z=1.537, P=0.124), and extrathyroidal invasion (χ2=1.028, P=0.311). Meanwhile, the serum 25-hydroxyvitamin D (t=4.588, P<0.01) was statistically significant. Multivariate Logistic regression analysis results showed that serum 25-hydroxyvitamin was an independent factor influencing ER (OR=0.849, 95%CI: 0.781–0.923, P<0.001). The cut-off value of serum 25-hydroxyvitamin D levels was 20.69 ng/ml, the area under curve for serum 25-hydroxyvitamin D levels was 0.736, the sensitivity and specificity were 77.00% and 63.60%, respectively.
    Conclusions  Serum 25-hydroxyvitamin D levels has certain predictive value for ER in DTC patients after initial 131I treatment.

     

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