局部晚期或转移性DTC的131I治疗疗效预测模型的构建与分析

Construction and analysis of a predictive model for the efficacy of 131I therapy in locally advanced or metastatic differentiated thyroid carcinoma

    摘要
  • 摘要:
    目的 探讨影响局部晚期或转移性分化型甲状腺癌（DTC）患者131I疗效的影响因素，并构建预测模型，为临床预后评估提供依据。
    方法 回顾性分析2016年1月至2023年9月于安徽省肿瘤医院接受131I治疗的437例局部晚期或转移性DTC患者的临床资料，其中男性168例、女性269例，年龄（46.8±0.7）岁。根据疗效评价标准将患者分为有效组和无效组。收集的观察指标包括性别、年龄、病理类型、病灶长径及血清学指标刺激状态下促甲状腺激素（TSH）、刺激性甲状腺球蛋白（sTg）、刺激状态下甲状腺球蛋白抗体（TgAb）水平，并计算sTg/TSH比值、sTg/TgAb比值。计量资料的组间比较采用Mann-Whitney U检验；计数资料的组间比较采用χ2检验。将单因素分析中差异有统计学意义的变量纳入多因素Logistic回归分析，筛选131I疗效的独立影响因素。基于独立影响因素，应用R4.4.2软件构建列线图预测模型，并绘制受试者工作特征（ROC）曲线计算曲线下面积（AUC），采用校准曲线和Hosmer-Lemeshow检验评价模型的拟合优度。
    结果  有效组患者269例，无效组患者168例。有效组与无效组相比，病灶长径0.76（0.50, 1.09 ） cm 对 1.89（1.50, 2.10） cm、sTg 3.46（0.72, 10.55）ng/ml 对 736.25（85.15，4672.58） ng/ml、sTg/TSH比值 0.06（0.01, 0.19） 对 32.10（2.94, 212.10）及sTg/TgAb 比值0.31（0.02, 1.27）对104.16（57.37, 136.41）的差异均有统计学意义（Z=−17.36~−11.63，均P<0.001）。多因素Logistic回归分析结果显示，病灶长径（OR=4.229，95%CI：1.161~15.400，P=0.029）、sTg水平（OR=1.236，95%CI：1.125~1.358，P<0.001）、sTg/TSH比值（OR=1.074，95%CI：1.015~1.137，P=0.014）及sTg/TgAb比值（OR=1.028，95%CI：1.005~1.051，P=0.029）均为131I疗效的独立影响因素。基于上述因素构建列线图预测模型，其AUC为0.881（95%CI：0.820~0.960，P=0.017），灵敏度为79.6%，特异度为85.9%。校准曲线显示该模型的预测概率与实际概率具有良好的一致性，Hosmer-Lemeshow检验结果显示该模型的拟合优度良好（χ2=0.914，P=0.996）。
    结论 成功构建的基于病灶长径、sTg水平、sTg/TSH比值及sTg/TgAb比值的131I疗效预测模型具有良好的预测效能，可为局部晚期及转移性DTC患者的预后评估提供参考。

     

    Abstract:
    Objective To identify factors influencing the efficacy of 131I therapy in patients with locally advanced or metastatic differentiated thyroid carcinoma (DTC) and develop a predictive model to inform clinical prognosis evaluation.
    Methods A retrospective analysis was conducted on 437 patients with locally advanced or metastatic DTC who underwent 131I therapy at Anhui Provincial Cancer Hospital between January 2016 and September 2023. The cohort included 168 males and 269 females, with an age of (46.8±0.7) years. Patients were categorized into effective and ineffective groups on the basis of treatment response criteria. Collected variables included gender, age, pathological type, lesion diameter, and serological markers such as stimulated thyroid-stimulating hormone (TSH), stimulated thyroglobulin (sTg), and stimulated thyroglobulin antibody (TgAb). The sTg/TSH ratio and sTg/TgAb ratio were calculated. Measurement data were compared using Mann-Whitney U test, and count data were compared using χ2 test. Variables with significant differences in univariate analysis were entered into multivariate Logistic regression to identify independent predictors of treatment efficacy. A nomogram prediction model was developed using R4.4.2 software on the basis of these factors. Model performance was assessed using the receiver operating characteristic (ROC) curve, with the area under the curve (AUC) calculated. Calibration curves and Hosmer-Lemeshow test were used to evaluate goodness of fit.
    Results The effective group comprised 269 patients, and the ineffective group had 168 patients. Significant intergroup differences were observed in lesion diameter (0.76 (0.50, 1.09) cm vs. 1.89 (1.50, 2.10) cm), sTg (3.46 (0.72, 10.55) ng/ml vs. 736.25 (85.15, 4 672.58) ng/ml), sTg/TSH ratio (0.06 (0.01, 0.19) vs. 32.10 (2.94, 212.10)), and sTg/TgAb ratio (0.31 (0.02, 1.27) vs. 104.16 (57.37, 136.41)) (Z=from –17.36 to –11.63, all P<0.001). Multivariate Logistic regression identified lesion diameter (OR=4.229, 95%CI: 1.161–15.400, P=0.029), sTg level (OR=1.236, 95%CI: 1.125–1.358, P<0.001), sTg/TSH ratio (OR=1.074, 95%CI: 1.015–1.137, P=0.014), and sTg/TgAb ratio (OR=1.028, 95%CI: 1.005–1.051, P=0.029) as independent predictors of 131I treatment efficacy. The nomogram model demonstrated an AUC of 0.881 (95%CI: 0.820–0.960, P=0.017), with a sensitivity of 79.6% and a specificity of 85.9%. The calibration curves showed good agreement between the predicted and observed outcomes, and the Hosmer-Lemeshow test indicated excellent goodness of fit (χ2=0.914, P=0.996).
    Conclusions A predictive model for the efficacy of 131I therapy in locally advanced or metastatic DTC was successfully established on the basis of lesion diameter, sTg level, sTg/TSH ratio, and sTg/TgAb ratio. The model demonstrates favorable predictive efficacy, and it may serve as a useful tool for prognostic evaluation in patients with locally advanced or metastatic DTC.

     

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