甲状腺乳头状癌术后患者TgAb水平变化及131I治疗疗效预测价值的研究

TgAb levels dynamics and 131I therapeutic efficacy prediction in postoperative papillary thyroid cancer

    摘要
  • 摘要:
    目的  探讨首次131I治疗前甲状腺球蛋白抗体（pa-TgAb）阳性的甲状腺乳头状癌（PTC）术后患者经131I治疗后甲状腺球蛋白抗体（TgAb）水平的变化趋势及其与疗效预测的关系。
    方法 回顾性分析2019年9月至2022年7月于天津医科大学总医院核医学科行131I治疗的980例PTC患者，最终纳入pa-TgAb阳性（≥40 IU/ml）且甲状腺球蛋白（Tg）水平<0.2 ng/l的患者172例（17.6%），其中男性33例、女性139例，年龄（44.2±12.1）岁。收集患者的临床资料、血清学和影像学检查结果。随访时间为24~46月，中位随访时间16.5月。根据首次清甲治疗后6个月的TgAb水平将患者分为G1组（TgAb水平<40 IU/ml）和G2组（TgAb水平≥40 IU/ml），比较G1组和G2患者的首次清甲成功率，分析末次清甲成功患者的TgAb转阴时间。根据末次清灶治疗后6个月的疗效评价将患者分为有效组和无效组，分析2组患者ΔTgAb的差异。计量资料的组间比较采用t检验或Mann-Whitney U检验；计数资料的组间比较采用χ2检验；采用多因素Logistic回归分析清甲治疗后TgAb转阴的影响因素；采用受试者工作特征（ROC）曲线分析确定影响TgAb转阴因素的最佳临界值和TgAb水平变化（ΔTgAb）的最佳临界值。
    结果 pa-TgAb阳性患者占17.6%（172/980）。142例行清甲治疗的患者中，失访10例（失访率为7%）。132例患者首次清甲治疗后6个月的清甲成功率为66.7%（88/132），G1组（76例）清甲成功率为75%（57/76），G2组（56例）清甲成功率为55.4%（31/56），2组的差异有统计学意义（χ2=7.724，P<0.01）。末次清甲治疗后6个月，清甲成功者122例，其中112例患者在随访期内TgAb转阴，72.1%（88/122）的患者在6个月内转阴，11.5%（14/122）在6个月~12个月转阴，8.2%（10/122）在12个月以上转阴。多因素Logistic回归分析显示，pa-TgAb水平、桥本甲状腺炎、N分期、手术与首次131I清甲治疗时间间隔是影响清甲治疗后TgAb转阴的影响因素（HR=0.998、4.054、0.414、0.989，均P<0.05）。pa-TgAb<226 IU/ml且手术与首次131I治疗时间间隔<62 d的患者在清甲成功后6个月TgAb更可能转阴。30例伴有转移灶的患者行清灶治疗，失访2例（失访率为6.7%）；其中有效组患者20例，无效组8例；有效组ΔTgAb 0.76 （0.64，0.89）%与无效组ΔTgAb -0.028（-0.59，0.21）%的差异有统计学意义（Z=−3.718，P<0.001）。ROC曲线分析结果表明，首次131I清甲治疗成功后，pa-TgAb水平<226 IU/ml且首次131I清甲治疗与手术时间间隔<62 d的阳性PTC患者6个月内TgAb转阴的可能性较大。131I清灶治疗患者的pa-TgAb水平<473 IU/ml、△TgAb > 62%时，预示疗效良好。
    结论  pa-TgAb水平、首次131I清甲治疗与手术时间间隔与131I清甲治疗的疗效密切相关，ΔTgAb可为预测患者131I清灶治疗的疗效提供参考依据。

     

    Abstract:
    Objective  To investigate the trend of thyroglobulin antibody (TgAb) level changes after radioiodine therapy (RAI) and its predictive value for treatment efficacy in postoperative papillary thyroid carcinoma (PTC) patients with preablative TgAb (pa-TgAb) positivity.
    Methods A retrospective analysis was conducted on 980 PTC patients who received 131I therapy in the Department of Nuclear Medicine at Tianjin Medical University General Hospital from September 2019 to July 2022. Ultimately, 172 pa-TgAb–positive (≥40 IU/ml) patients with thyroglobulin (Tg) <0.2 ng/ml were enrolled (33 males, 139 females; mean age 44.2±12.1 years). Clinical data, serological results, and imaging findings were collected. The follow-up period ranged from 24 to 46 months (median 16.5 months). Based on TgAb levels six months after initial 131I remnant ablation, the patients were divided into Group G1 (TgAb<40 IU/ml) and Group G2 (TgAb≥40 IU/ml). Successful ablation rates was compared between two groups. TgAb seroconversion time was analyzed in patients with successful ablation. Efficacy of metastatic lesion treatment was evaluated 6 months after the last RAI, with patients divided into response and non-response groups; ΔTgAb (TgAb change rate) was compared. For continuous data, inter-group comparisons were performed using the t-test or Mann-Whitney U test; for categorical data, inter-group comparisons were performed using the χ² test. Multivariate logistic regression identified factors influencing TgAb seroconversion. Receiver operating characteristic (ROC) curves determined optimal cutoff values for predictive factors influencing TgAb seroconversion and delta thyroglobulin antibodies (ΔTgAb).
    Results  Among the 980 patients, 17.6% (172/980) were pa-TgAb positive. Of the 142 patients who underwent 131I remnant ablation, 10 were lost to follow-up (7%). Six months after the initial remnant ablation in 132 patients, the success rate was 66.7% (88/132). Significant difference between G1 (75%, 57/76) and G2 (55.4%, 31/56) (χ2=7.724, P<0.01). Among 122 patients with successful ablation, 112 achieved TgAb seroconversion.72.1% (88/122) within 6 months, 11.5% (14/122) at 6–12 months, and 8.2% (10/122) after 12 months. pa-TgAb level (HR=0.998, P=0.036), Hashimoto′s thyroiditis (HR=4.054, P=0.006), N stage (HR=0.414, P=0.010), and surgery-to-RAI interval (HR=0.989, P=0.002) independently influenced TgAb seroconversion (coefficient data missing in original). Patients with pa-TgAb <226 IU/ml and surgery-to-RAI interval <62 days were more likely to become negative within six months. 30 patients with metastatic lesions underwent 131I therapy, 2 were lost to follow-up (6.7%). ΔTgAb was significantly higher in the response group (n=20; 0.76 (0.64, 0.89)%) vs. non-response (n=8; –0.028 (–0.59, 0.21)%; Z=−3.718, P<0.001). pa-TgAb <473 IU/ml and ΔTgAb >62% predicted favorable metastatic treatment efficacy.
    Conclusions  pa-TgAb levels and surgery-to-RAI interval are critical predictors for RAI efficacy in ablation. ΔTgAb serves as a valuable biomarker for anticipating therapeutic outcomes in metastatic PTC.

     

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