摘要： 目的·在分化型甲状腺癌（differentiated thyroid carcinoma，DTC）合并结节性甲状腺肿（nodular goitre，NG）患者中，评估术后碘消融前促甲状腺素（thyroid stimulating hormone，TSH）刺激性甲状腺球蛋白（preablative stimulated thyroglobulin，ps-Tg）作为早期预后指标的作用，确定ps-Tg预测该病复发或转移的最佳截断值。方法·回顾性分析接受甲状腺全切术和放射性
131I 治疗的268例DTC合并NG患者的病例资料。采用Logistic回归分析评价ps-Tg和其他临床病理特征在术后早期阶段肿瘤远处转移中的预测意义。通过受试者操作特征（receiver operating characteristic，ROC）曲线分析，确定在DTC合并NG患者中ps-Tg预测复发或转移的最佳临界点。结果·Logistic分析结果显示，ps-Tg（
OR=1.002，
P=0.005）、N
1b（
OR=0.235，
P＝0.001）和组织病理类型（
OR=0.263，
P=0.012）是肿瘤远处转移的预测因子。ps-Tg预测疾病复发或转移的最佳截断值为26.97 ng/mL，敏感度和特异度分别为66.7%和83.3%，ROC曲线下面积为0.795。结论·对于DTC合并NG患者，ps-Tg、N
1b和组织病理类型对术后早期肿瘤复发或转移有重要预测意义；Ps-Tg的截断值有助于预测肿瘤的复发或转移。
关键词: 分化型甲状腺癌, 结节性甲状腺肿, 消融前刺激性甲状腺球蛋白 Abstract: Objective·To evaluate the role of preablative stimulated thyroglobulin (ps-Tg) as an early prognostic marker for patients with differentiated thyroid carcinoma (DTC) complicated with nodular goitre (NG) after operation and determine the corresponding cut-off value.
Methods·A total of 268 patients with DTC complicated with NG who underwent the 131I treatment and thyroidectomy were analyzed. Logistic regression analysis were performed to evaluate baseline ps-Tg and other clinicopathologic characteristics in the prediction of distant metastasis. The receiver operating characteristic (ROC) curve analysis was conducted to analyze optimal cut-off point of ps-Tg for predicting the recurrence or metastasis for patients with DTC complicated with NG.
Results·In the Logistic analysis, ps-Tg (OR=1.002, P=0.005), N1b (OR=0.235, P＝0.001) and the histological-pathological types (OR=0.263, P=0.012) were predictors of distant metastasis. The cut-off value of ps-Tg for predicting the recurrence or metastasis was 26.97 ng/mL, with sensitivity of 66.7% and specificity of 83.3%. Area under the ROC curve was 0.795.
Conclusion·For patients with DTC complicated with NG, ps-Tg, N1b and the histological- pathological types have a significant prognostic implication in early postoperative metastasis or recurrence. The cut off value of ps-Tg could be more useful for the prediction of metastasis or recurrence.
Key words: differentiated thyroid carcinoma (DTC), nodular goitre (NG), preablative stimulated thyroglobulin (ps-Tg) PDF全文下载地址:
点我下载PDF 