血清Tg、TgAb对甲状腺癌根治术联合131I治疗后随访期间复发/转移的评估价值

Evaluation value of serum Tg and TgAb values for recurrence/metastasis during follow-up period after radical thyroidectomy combined with 131I treatment

摘要:

目的 研究血清甲状腺球蛋白（Tg）、甲状腺球蛋白抗体（TgAb）对甲状腺癌根治术联合¹³¹I治疗后随访期间复发/转移的评估价值。方法 回顾性分析2018年6月—2020年6月中国贵航集团三〇二医院收治的106例分化型甲状腺癌患者的临床资料，患者均接受甲状腺癌根治术治疗，术后均采用¹³¹I进行清除残留的甲状腺组织（清甲）治疗。随访24个月，将患者分为复发转移组（21例）和未复发转移组（85例）。比较两组临床资料、¹³¹I治疗情况及血清促甲状腺激素（TSH）、Tg、TgAb。绘制受试者工作特征（ROC）曲线分析血清Tg、TgAb检测对甲状腺癌根治术联合¹³¹I治疗后复发/转移的预测价值。采取非条件一般Logistic回归模型进行多因素分析。结果 与未复发转移组比较，复发转移组原位肿瘤T₄分期、手术方式为腺叶切除或近全切、残余甲状腺质量≥1 g、手术至¹³¹I治疗时间> 3个月、24 h摄¹³¹I率≤ 20%患者的占比均较高（P <0.05）；复发转移组血清Tg和TgAb水平均较高（P <0.05）；ROC曲线分析结果显示：血清Tg预测甲状腺癌根治术联合¹³¹I治疗后复发或转移的最佳截断值为1.674 μg/L，AUC为0.803（95% CI：0.721，0.884），敏感性为81.1%（95% CI：0.724，0.898），特异性为63.8%（95% CI：0.585，0.691）；血清TgAb预测的最佳截断值为44.19 3 IU/mL，AUC为0.911（95% CI：0.859，0.963），敏感性为89.2%（95% CI：0.813，0.971），特异性为72.5%（95% CI：0.674，0.774）。非条件Logistic一般回归分析结果显示：原位肿瘤T₄分期［O^R=2.916（95% CI：1.325，6.417）］、腺叶切除或近全切［O^R=3.243（95% CI：2.174，4.838）］、残余甲状腺质量≥ 10 g［O^R=1.835（95% CI：1.514，2.224）］、手术至¹³¹I治疗时间> 3个月［O^R=1.962（95% CI：1.371，2.808）］、24 h摄¹³¹I率≤ 20%［O^R=2.638（95% CI：1.219，5.709）］、血清Tg ≥ 1.674 μg/L［O^R=2.503（95% CI：1.430，4.360）］、血清TgAb≥ 44.193 IU/mL［O^R=2.944（95% CI：2.016，4.299）］可能是甲状腺癌根治术联合¹³¹I治疗后复发或转移的危险因素（P <0.05）；风险因素预测模型预测甲状腺癌根治术联合¹³¹I治疗后复发/转移的ROC曲线下面积为0.961（95% CI：0.935，0.987），标准误为0.010，临界值为73.162，敏感性为91.9%（95% CI：0.863，0.957），特异性为88.2%（95% CI：0.845，0.922）。结论 甲状腺癌根治术联合¹³¹I治疗后出现复发/转移的患者血清Tg、TgAb水平明显升高，Tg、TgAb对预测复发/转移具有较好的价值，联合其他危险因素建立风险因素预测模型可进一步提高预测价值。

关键词:分化型甲状腺癌;甲状腺癌根治术;¹³¹I治疗;复发/转移;甲状腺球蛋白;甲状腺球蛋白抗体

Abstract:

Objective To study the value of serum thyroglobulin (Tg) and thyroglobulin antibody (TgAb) in the evaluation of recurrence/metastasis during the follow-up period after radical thyroidectomy combined with ¹³¹I.Methods Retrospective analysis was made on the clinical data of 106 patients with differentiated thyroid cancer admitted to our hospital. The time of inclusion was from June 2018 to June 2020. All patients received radical surgery for thyroid cancer, and ¹³¹I was used for nail removal after surgery. The patients were followed up for 24 months, and were divided into recurrent metastatic group (21 cases) and non recurrent metastatic group (85 cases).The clinical data, ¹³¹I treatment and serum thyroid stimulating hormone (TSH), Tg and TgAb were compared between the two groups.Results The recurrence/metastasis group had a higher proportion of patients with T₄ staging, adenolobectomy or near-total thyroidectomy, residual thyroid mass ≥ 1 g, time from surgery to ¹³¹I therapy > 3 months, and 24-hour ¹³¹I uptake rate ≤ 20% (P < 0.05). Serum Tg and TgAb levels were also significantly higher in the recurrence/metastasis group (P < 0.05). ROC curve analysis revealed that the optimal cutoff value for serum Tg to predict recurrence or metastasis was 1.674 μg/L, with an AUC of 0.803 (95% CI: 0.721, 0.884), sensitivity of 81.1% (95% CI: 0.724, 0.898), and specificity of 63.8% (95% CI: 0.585, 0.691). The optimal cutoff value for serum TgAb to predict recurrence or metastasis was 44.193 IU/mL, with an AUC of 0.911 (95% CI: 0.859, 0.963), sensitivity of 89.2% (95% CI: 0.813, 0.971), and specificity of 72.5% (95% CI: 0.674, 0.774). Multivariate logistic regression analysis identified several risk factors, including T4 staging, adenolobectomy or near-total thyroidectomy, residual thyroid mass ≥ 10 g, time from surgery to ¹³¹I therapy > 3 months, 24-hour ¹³¹I uptake rate ≤ 20%, serum Tg ≥ 1.674 μg/L, and serum TgAb ≥ 44.193 IU/mL (P < 0.05). The risk factor prediction model had an AUC of 0.961 (95% CI: 0.935, 0.987), sensitivity of 91.9% (95% CI: 0.863, 0.957), and specificity of 88.2% (95% CI: 0.845, 0.922).Conclusion The serum Tg and TgAb levels of patients with recurrence or metastasis of thyroid cancer after radical thyroidectomy combined with ¹³¹I treatment increased significantly. It is of good value to predict recurrence or metastasis. The prediction value can be further improved by establishing a risk factor prediction model combined with other risk factors.

Key words:differentiated thyroid carcinoma;radical thyroidectomy;¹³¹I treatment;recurrence and metastasis;thyroglobulin;thyroglobulin antibody