中国癌症杂志 ›› 2019, Vol. 29 ›› Issue (6): 429-433.doi: 10.19401/j.cnki.1007-3639.2019.06.005

• 专家述评与论著 • 上一篇    下一篇

治疗前刺激性甲状腺球蛋白阴性合并淋巴结转移的分化型甲状腺癌131I治疗后的临床转归

卢承慧,李 娇,刘新峰,王国强,王增华,王叙馥   

  1. 青岛大学附属医院核医学科,山东 青岛266003
  • 出版日期:2019-06-30 发布日期:2019-07-12
  • 通信作者: 王叙馥 E-mail: wangxufu@sina.com

Clinical outcome after 131I treatment in differentiated thyroid cancer with negative stimulated thyroglobulin and lymph node metastasis

LU Chenghui, LI Jiao, LIU Xinfeng, WANG Guoqiang, WANG Zenghua, WANG Xufu   

  1. Department of Nuclear Medicine, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
  • Published:2019-06-30 Online:2019-07-12
  • Contact: WANG Xufu E-mail: wangxufu@sina.com

摘要: 背景与目的:治疗前刺激性甲状腺球蛋白(preablative stimulated thyroglobulin,ps-Tg)阴性和131I显像阴性往往提示分化型甲状腺癌(differentiated thyroid cancer,DTC)患者无病生存状态,然而临床上常遇到ps-Tg阴性伴131I显像示淋巴结转移的情况。探讨甲状腺全切术后ps-Tg阴性伴131I显像示淋巴结转移患者的临床转归及其影响因素。方法:2015年5月—2018年1月在青岛大学附属医院首次行131I治疗的ps-Tg<2 ng/mL伴淋巴结转移的DTC患者130例,随访6~36个月,根据临床转归情况分为满意(excellent response,ER)、不确切(indeterminate response,IDR)、影像学反应欠佳(structural incomplete response,SIR)3组,比较3组患者的性别、年龄、原发肿瘤大小、腺外浸润、T分期、术后N分期、淋巴结转移率、复发风险分层、131I治疗剂量、ps-Tg及甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)等特征的差异,对有意义的因素进一步行亚组分析。结果:3组患者在N分期(χ2=11.274,P=0.024)、ps-Tg(H=9.579,P=0.008)和TgAb(H=11.632,P=0.003)方面差异有统计学意义,在性别(χ2=0.559,P=0.756)、年龄(F=0.408,P=0.666)、原发肿瘤大小(H=1.834,P=0.400)、腺外浸润(χ2=1.345,P=0.510)、T分期(χ2=4.494,P=0.610)、淋巴结转移率(H=3.358,P=0.187)、复发风险分层(χ2=3.008,P=0.556)和首次131I治疗剂量(H=1.335,P=0.513)方面差异均无统计学意义。术后分期N0组14例,100.00%(14/14)达到ER,N1a组18例,其中77.78%(14/18)达ER,22.22%(4/18)达IDR,N1b组98例,63.26%(62/98)达ER,18.37%(18/98)达IDR,18.37%(18/98)达SIR。IDR组的中位ps-Tg水平为1.85 ng/mL显著高于ER组的1.09 ng/mL(t=2.976,P=0.003)和SIR组的0.39 ng/mL(t=2.468,P=0.014),而SIR组的中位TgAb水平为713.10 U/mL,显著高于ER组的40.42 U/mL(t=3.409,P=0.001)和IDR组的39.02 U/mL(t=2.381,P=0.017)。结论:对于ps-Tg阴性、首次131I治疗后扫描发现淋巴结转移的患者,术后N分期、ps-Tg及TgAb水平可作为预测其临床转归的敏感指标。术后分期为N1b、ps-Tg水平很低但TgAb水平明显升高者更易出现治疗反应欠佳。

关键词: 分化型甲状腺癌, 淋巴结转移, 甲状腺球蛋白, 131I治疗

Abstract: Background and purpose: Negative pre-ablative stimulated thyroglobulin (ps-Tg) with negative 131I scan indicates disease-free survival of patients with differentiated thyroid cancer (DTC). However, negative ps-Tg with lymph node metastasis detected by 131I scan often shows in clinic. The purpose of this study was to investigate the prognosis of postoperative DTC patients with lymph node metastasis and negative ps-Tg and its influencing factors. Methods: From May 2015 to Jan. 2018, 130 DTC patients with lymph node metastasis who underwent 131I treatment for the first time in the Affiliated Hospital of Qingdao University were followed up for 6-36 months. According to the clinical outcome, they were divided into 3 groups: excellent response (ER), indeterminate response (IDR) and structural incomplete response (SIR). The gender, age, size of primary tumor, extraglandular infiltration, T stage, N stage, lymph node metastasis rate, recurrence risk stratification, ps-Tg and thyroglobulin antibody (TgAb) were compared among the three groups. Subgroup analysis of significant factors was further carried out. Results: There were significant differences in N stage (χ2=11.274, P=0.024), ps-Tg (H=9.579, P=0.008) and TgAb (H=11.632, P=0.003) among groups. There was no significant difference in gender (χ2=0.559, P=0.756), age (F=0.408, P=0.666), primary tumor size (H=1.834, P=0.400), extraglandular infiltration (χ2=1.345, P=0.510), T stage (χ2=4.494, P=0.610), lymph node metastasis rate (H=3.358, P=0.187), recurrence risk stratification (χ2=3.008, P=0.556) and dose of radioiodine (H=1.335, P=0.513). 100% (14/14) reached ER in N0 group. 77.78% (14/18) reached ER, and 22.22% (4/18) reached IDR in N1a group. 63.26% (62/98) reached ER, 18.37% (18/98) reached IDR, and 18.37% (18/98) reached SIR in N1b group. The median ps-Tg level in IDR group was 1.85 ng/mL, significantly higher than that in ER group (t=2.976, P=0.003) and SIR group (t=2.468, P=0.014). The median TgAb level in SIR group was 713.1 U/mL, significantly higher than that in ER group (40.42 U/mL, t=3.409, P=0.001) and IDR group (39.02 U/mL, t=2.381, P=0.017). Conclusion: N stage, ps-Tg and TgAb levels can be used as sensitive indicators for predicting clinical outcomes in DTC patients with negative ps-Tg and lymph node metastasis after the first 131I treatment. The prognosis of patients with N0 stage is better, and those with N1b, low ps-Tg level but significantly elevated TgAb level are more likely to have poor treatment response.

Key words: Differentiated thyroid carcinoma, Lymph node metastasis, Thyroglobulin, 131I therapy