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    术后病理颈淋巴结转移中低危甲状腺乳头状癌病人131I治疗短期疗效影响因素分析

    Analysis of influencing factors on short-term efficacy of 131I treatment for medium to low risk classification PTC patients with postoperative pathological cervical lymph node metastasis

      摘要
    • 摘要: 目的：探究术后病理颈淋巴结转移中低危甲状腺乳头状癌(PTC)病人131I治疗短期效果及影响因素。方法：分析131I治疗111例术后病理颈淋巴结转移中低危PTC资料。按疗效分满意(ER)组和非满意(NER)组。对2组临床特征数据进行分析，多因素logistic回归对131I治疗后短期疗效影响因素进行评估，受试者工作特征(ROC)曲线对刺激性甲状腺球蛋白(ps-Tg)预测疗效的价值进行评估。结果：ER组81例，占73.0%；NER组30例，占27.0%。与ER组相比，NER病人在肿瘤最大径、转移淋巴结数目、转移淋巴结比率、ps-Tg均高，差异均有统计学意义(P<0.05～P<0.01)。logistic回归分析显示ps-Tg值增高可能是NER的独立危险因素(OR=1.108，95%CI:1.046~1.174，P<0.01)。ROC曲线分析示，ps-Tg水平可用于131I治疗后短期疗效预测，界值为15.41 ng/mL，灵敏度是83.3%、特异度是76.5%。结论：术后病理颈淋巴结转移的中低危PTC病人131I治疗后短期效果与肿瘤最大径、转移淋巴结数目、ps-Tg、转移淋巴结比率有关，预测131I治疗短期效果的独立影响因素是ps-Tg。病人131I治疗后73.0%的病人可以达到ER，ps-Tg>15.41 ng/mL的病人治疗疗效较差。

       

      Abstract: Objective: To investigate the short-term efficacy and influencing factors of 131I treatment for medium to low risk classification papillary carcinoma of the thyroid(PTC) patients with postoperative pathological cervical lymph node metastasis. Methods: The data of 111 cases of postoperative pathological cervical lymph node metastasis with medium to low risk classification PTC treated with 131I were analyzed.They were divided into excellent response (ER) group and non-excellent response (NER) group according to therapeutic effect.Two sets of clinical characteristic data were analyzed,the influencing factors of short-term efficacy after 131I treatment were evaluated using multivariate logistic regression,and the value of receiver operating characteristic(ROC) curve was evaluated in predicting efficacy of ps-Tg. Results: There were 81 cases in the ER group,accounting for 73.0%,and 30 cases in the NER group,accounting for 27.0%.Compared with the ER group,the maximum tumor diameter,the number of metastatic lymph nodes,the ratio of metastatic lymph nodes and ps-Tg were higher in the NER patients,and the differences were statistically significant (P<0.05 to P<0.01).Logistic regression analysis showed that the increase of ps-Tg value might be an independent risk factor for NER (OR=1.108,95%CI:1.046-1.174,P<0.01).ROC curve analysis showed that ps-Tg level could be used to predict short-term efficacy after 131I treatment,with a cut-off value of 15.41 ng/mL,sensitivity of 83.3% and specificity of 76.5%. Conclusions: The short-term effect of 131I treatment on medium to low risk classification PTC patients with postoperative pathological cervical lymph node metastasis is related to the maximum diameter of the tumor,the number of metastatic lymph nodes,ps-Tg,and the ratio of metastatic lymph nodes.The independent influencing factor for predicting the short-term effect of 131I treatment is ps-Tg.Seventy-three percent of patients can achieve ER after 131I treatment,while patients with ps-Tg>15.41 ng/mL have poorer treatment efficacy.

       

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