中国癌症杂志 ›› 2016, Vol. 26 ›› Issue (1): 67-72.doi: 10.3969/j.issn.1007-3969.2016.01.011

• 论著 • 上一篇    下一篇

甲状腺乳头状癌淋巴结转移率与131I治疗后临床转归的关系

高 文1,2 ,梁 军1,赵 腾1,李 娇1,林岩松2   

  1. 1. 青岛大学附属医院肿瘤科,山东 青岛 266003 ;
    2. 中国医学科学院北京协和医院核医学科,北京 100730
  • 出版日期:2016-01-30 发布日期:2016-02-26
  • 通信作者: 林岩松 E-mail: linys@pumch.cn
  • 基金资助:
    国家自然科学基金(81571714);卫生部行业科研专项项目(201202012)。

The impact of lymph node metastatic rate on clinical outcome following 131I therapy in patients with papillary thyroid carcinoma

GAO Wen1,2, LIANG Jun1, ZHAO Teng1, LI Jiao1, LIN Yansong2   

  1. 1.Department of Oncology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China; 2.Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Published:2016-01-30 Online:2016-02-26
  • Contact: LIN Yansong E-mail: linys@pumch.cn

摘要: 背景与目的:甲状腺乳头状癌(papillary thyroid carcinoma,PTC)常伴淋巴结转移,该研究旨在探讨PTC患者的淋巴结转移率(lymph node metastatic rate,LR,即转移淋巴结数/切除淋巴结总数)与经131I清甲治疗后临床转归的关系及其预测价值。方法:随访PTC患者143例,根据LR将其分为Ⅰ组(0~10%,n=22)、Ⅱ组(10%~25%,n=51)、Ⅲ组(25%~50%,n=52)和Ⅳ组(>50%,n=18),经过131I清甲治疗后20.7个月的中位随访,根据2015年美国甲状腺协会指南的治疗反应将患者的临床转归分为:满意(excellent response,ER)、不确切(indeterminate response,IDR)和反应欠佳[血清学反映欠佳(biochemical incomplete response,BIR)、影像学反应欠佳(structural incomplete response,SIR)],采用单因素方差分析、χ2检验和Kruskal-Wallis秩和检验比较4组患者的基本临床特征和临床转归;应用受试者工作特征(receiver operating characteristic,ROC)曲线评估LR在预测ER的价值及最佳界值点,并进一步通过多因素分析评估LR是否可以作为预测ER的独立因素。结果:4组患者的性别、肿瘤T分期差异无统计学意义(P均>0.05),Ⅰ组年龄显著高于其他3组(F=6.114,P=0.001)。随LR增高,临床转归达到ER者呈下降趋势,同时BIR及SIR者总体呈升高趋势。其中,Ⅳ组的治疗反应ER率明显低于其他3组(27.8%),而更易呈现为BIR(27.8%)和SIR(11.1%)(H=18.816,P=0.000)。LR可以作为预测ER的独立因素(OR=10.011,P=0.000),当其为52.27%时对预测ER具有较高特异性(95.09%),ROC曲线下面积为0.668(P=0.002)。结论:随LR增高患者131I清甲治疗后更易出现较差的临床转归,LR为52.27%的界值点可作为预测临床转归的独立特异性指标。

关键词: 甲状腺癌乳头状癌, 淋巴结转移率, 131I治疗, 临床转归

Abstract: Background and purpose: This study aimed to investigate the relationship between lymph node metastatic rate (LR) and response to radioiodine therapy in patients with papillary thyroid carcinoma (PTC). Methods: A total number of 143 PTC patients after radioiodine therapy were included and classified into 4 groups [Ⅰ(0%-10%),Ⅱ(>10%-25%), Ⅲ(>25%-50%), Ⅳ(>50%)] according to the lymph node metastatic rate, and the responses to initial radioiodine therapy after a median follow-up period of 20.7 months were evaluated. They were classified into 4 groups [excellent response (ER), indeterminate response (IDR), biochemical incomplete response (BIR), and structural incomplete response (SIR)] according to the guideline proposed by 2015 American Thyroid Association. One-Way analysis of variance, χ2 test and Kruskal-Wallis test were used to evaluate the differences in basic clinicopathological features and clinical responses among the 4 groups. The ROC curve was analyzed to evaluate the clinical value of lymph node metastatic rate for predicting ER and optimal cut-off point. Results: There were no significant differences in gender and T-stage among 4 groups (P>0.05). However,Ⅰ group was significantly older than the other 3 groups (P=0.001). With the increase of lymph node metastatic rate, the number of ER cases decreased, while cases of BIR and SIR generally increased. Compared with the other 3 groups, less cases of ER (27.8%), while more BIR (27.8%) or SIR (11.1%) were observed in group Ⅳ (H=18.816, P=0.000). Cut-off value of lymph node involved rate was 52.27%, with a better specificity of predicting ER. Area under the ROC curve was 0.668. Conclusion: The higher lymph node metastatic rate in patients with PTC, the worse clinical outcome it could be. A cut-off value of lymph node metastatic rate 52.27% is a specific independent predictor for the clinical outcome in PTC patients treated with radioiodine therapy.

Key words: Papillary thyroid carcinoma, Lymph node metastatic rate, Radioiodine remnant ablation, Clinical outcome