基于局部晚期及转移性分化型甲状腺癌的131I治疗疗效预测模型构建与分析

Construction and analysis of a predictive model for the efficacy of 131I therapy in locally advanced and 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治疗疗效的影响因素，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首次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（269例）和无效组（168例）。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）、甲状腺球蛋白抗体（TgAb）水平、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回归模型，筛选131I疗效的独立影响因素。基于独立影响因素，应用R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检验评价模型拟合优度。
    结果  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 32.1（2.94, 212.10）及sTg/TgAb 比值0.31（0.02, 1.27）对104.16（57.37, 136.41）差异均有统计学意义（Z=−11.63、17.36、−16.52、−16.75 ，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），灵敏度为79.6%，特异度为85.9%。校准曲线显示预测概率与实际观测概率具有良好的一致性，Hosmer-Lemeshow检验提示模型校准度良好（χ2=0.914，P=0.996）。
    结论 本研究成功构建基于病灶长径、sTg水平、sTg/TSH比值及sTg/TgAb比值的131I疗效预测模型，该模型具有良好的预测效能，可为局部晚期或转移性DTC患者的预后评估和个体化治疗提供参考。

     

    Abstract:
    Objective To analyze the influencing factors of radioiodine (131I) therapy in locally advanced or metastatic differentiated thyroid cancer (DTC), and develop a predictive model to provide a reference for the prognosis of patients.
    Methods The clinical data of 437 patients with locally advanced or metastatic DTC who underwent surgical resection and 131I therapy in our hospital from January 2016 to September 2023 were collected. According to the treatment effect, they were divided into valid group (n=269) and invalid group (n=168). Multivariate logistic regression was used to analyze the influencing factors of 131I efficacy, draw nomogram and build efficacy prediction models.
    Results The maximum diameter of the lesion0.76(0.50, 1.09) cm vs 1.89(1.50, 2.10) cm、sTg 3.46(0.72, 10.545) ng/mL vs 736.25(85.15, 4672.58) ng/mL、sTg/TSH 0.062(0.011, 0.189) vs 32.1(2.94, 212.1) and sTg/TgAb 0.308(0.023, 1.273) vs 104.16(57.37, 136.41) and sTg/TgAb 0.308(0.023, 1.273) vs 108.27(100.81, 128.86) were all lower than those in the invalid group (P<0.05); multivariate logistic regression analysis showed that the maximum diameter of the lesion, sTg, sTg/TSH and sTg/TgAb (OR=4.229, 95%CI: 1.161-15.400; OR=1.236, 95%CI: 1.125-1.358; OR=1.074, 95%CI: 1.015-1.137; OR=1.028, 95%CI:1.005-1.051) were factors influencing the efficacy of 131I in patients with locally advanced or metastatic DTC; the ROC curve AUC value is 0.884(95%CI: 0.820~0.960).
    Conclusions This study constructed an efficacy prediction model based on the influencing factors of 131I efficacy in locally advanced or metastatic DTC, which has good predictive performance.

     

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