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<sup>131</sup>I治疗后的临床转归

卢承慧; 刘新峰; 王国强; 王增华; 王叙馥

doi:10.19401/j.cnki.1007-3639.2019.06.005

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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

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- 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
- Clinical outcome after¹³¹I treatment in differentiated thyroid cancer with negative stimulated thyroglobulin and lymph node metastasis
- 中国癌症杂志 2019年29卷第6期页码：429-433
- 作者机构：
  
  青岛大学附属医院核医学科,山东,青岛,266003
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2019.06.005
  中图分类号： R736.1
- 网络出版：2019-07-12，
  
  纸质出版：2019-07-12
- 稿件说明：
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卢承慧，李娇，刘新峰，王国强，王增华，王叙馥. 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

卢承慧, 刘新峰, 王国强, et al. Clinical outcome after¹³¹I treatment in differentiated thyroid cancer with negative stimulated thyroglobulin and lymph node metastasis[J]. China Oncology, 2019, 29(6): 429-433.
卢承慧，李娇，刘新峰，王国强，王增华，王叙馥. 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 DOI： 10.19401/j.cnki.1007-3639.2019.06.005.

卢承慧, 刘新峰, 王国强, et al. Clinical outcome after¹³¹I treatment in differentiated thyroid cancer with negative stimulated thyroglobulin and lymph node metastasis[J]. China Oncology, 2019, 29(6): 429-433. DOI： 10.19401/j.cnki.1007-3639.2019.06.005.

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

131

I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

131

I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

131

I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

131

I治疗的ps-Tg2 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、

131

I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（χ

=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（χ

=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（χ

=1.345，P=0.510）、T分期（χ

=4.494，P=0.610）、淋巴结转移率（H=3.358，P=0.187）、复发风险分层（χ

=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N

组14例，100.00%（14/14）达到ER，N

组18例，其中77.78%（14/18）达ER，

22.22%（4/18）达IDR，N

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

131

I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N

、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。

Abstract

Background and purpose: Negative pre-ablative stimulated thyroglobulin (ps-Tg) with negative

131

I scan indicates disease-free survival of patients with differentiated thyroid cancer (DTC). However

negative ps-Tg with lymph node metastasis detected by

131

I 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

131

I 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 (χ

=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 (χ

=0.559

P=0.756)

age (F=0.408

P=0.666)

primary tumor size (H=1.834

P=0.400)

extraglandular infiltration (χ

=1.345

P=0.510)

T stage (χ

=4.494

P=0.610)

lymph node

metastasis rate (H=3.358

P=0.187)

recurrence risk stratification (χ

=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 N

group. 63.26% (62/98) reached ER

18.37% (18/98) reached IDR

and 18.37% (18/98) reached SIR in N

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

131

I treatment. The prognosis of patients with N

stage is better

and those with N

low ps-Tg level but significantly elevated TgAb level are more likely to have poor treatment response.

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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

Clinical outcome after131I treatment in differentiated thyroid cancer with negative stimulated thyroglobulin and lymph node metastasis

DOI：10.19401/j.cnki.1007-3639.2019.06.005

摘要

Abstract

关键词

Keywords

references

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

Clinical outcome after¹³¹I treatment in differentiated thyroid cancer with negative stimulated thyroglobulin and lymph node metastasis