摘要
目的:探讨分化型甲状腺癌(DTC)患者术后行再次131 I治疗前刺激性甲状腺球蛋白(sTg)与淋巴结转移、转移灶数目和直径的关系,并通过ROC曲线评估sTg及sTg/抑制性Tg(sup-Tg)比值对淋巴结转移的预测价值。方法:选取DTC术后再次131 I治疗的患者109例,根据131 I显像(whole body scan,WBS)等影像学结果以及转移癌灶数目、直径分组,分别比较各组间sTg的差异;分析转移灶数目、直径与sTg水平的相关性;通过ROC曲线,获得sTg预测淋巴结转移的最佳诊断界值点,对sTg<最佳诊断界值点的患者进一步行sTg/sup-Tg与淋巴结转移关系的ROC曲线,获得预测淋巴结转移的sTg/sup-Tg最佳诊断界值点。结果:淋巴结转移组以及其中的颈侧加纵隔区、中央区转移各组中sTg水平均高于无转移组,差异有统计学意义(分别H=-6.100、-3.974、-5.865,均P<0.05)。淋巴结转移组sTg水平转移灶数目≥3处组高于2处组高于1处组(H=21.791、-16.457、-31.680、-15.223,均P<0.05);转移灶直径>2 cm组高于1.1~2 cm组高于≤1 cm组(H=36.127、-22.867、-46.326、-23.458,均P<0.05);Spearman相关分析显示:淋巴结转移灶数目、直径均与sTg水平呈正相关(r=0.581、0.527,均P=0.000)。再次131 I治疗前sTg预测淋巴结转移的曲线下面积为0.879,最佳诊断界值点为4.615 ng/ml,约登指数为0.615,对应的敏感度、特异度和准确性分别为84.80%、76.70%和82.57%。sTg<4.615 ng/ml的35例患者,其sTg/sup-Tg比值预测淋巴结转移的ROC曲线下面积为0.935,最佳诊断界值点为4.559,灵敏度、特异度和准确率分别为91.70%、95.70%和94.29%。结论:sTg对DTC术后再次131 I治疗前淋巴结转移及转移灶数目、直径均有一定的预测价值。sTg联合sTg/sup-Tg比值可提高对DTC患者转移灶的检出率。
Objective:To explore the relationship between the stimulated thyroglobulin(sTg)and lymph node metastasis,the number and size of metastases in patients with differentiated thyroid carcinoma(DTC)before the second 131I ablation.And to evaluate the predictive value of sTg and sTg/sup-Tg for lymph node metastasis via ROC curve.Methods:109 DTC patients who received the second 131I ablation were divided into groups according to the imaging results,number and diameter of metastases to compare the sTg levels between different groups and analyze the correlation between the number and diameter of metastases and the sTg level.The ROC curve was used to explore the predictive value of the sTg level for lymph node metastasis,and patients whose sTg under the boundary value were further evaluate the relationship between sTg/sup-Tg and lymph node metastasis via ROC curve.Results:The sTg level of lymph node metastasis group and the cervical and mediastinal region and central region metastasis group were higher than that of non-metastatic group,and the difference was statistically significant(H=-6.100,-3.974,-5.865,all P<0.05).The sTg level in number of foci≥3 was higher than number of foci with 2 and 1(H=21.791,-16.457,-31.680,-15.223,all P<0.05),and the sTg level diameter of foci>2 cm was higher than diameter of foci with 1.1~2 cm and≤1 cm(H=36.127,-22.867,-46.326,-23.458,all P<0.05).The Spearman correlation analysis showed that the sTg level was positive correlated with the number and diameter of metastases.The area under the curve of sTg predicting lymph node metastasis before the second 131I ablation was 0.879.The best cut-off value was 4.615 ng/ml.The Yoden index was 0.615.The sensitivity,specificity and accuracy were 84.80%,76.70%and 82.57%.In 35 patients with sTg<4.615 ng/ml,the area under the ROC curve of sTg/sup-Tg ratio predicting lymph node metastasis was 0.935.The optimal cut-off value was 4.559.The sensitivity,specificity and accuracy were 91.70%,95.70%and 94.29%.Conclusion:The sTg level before the second 131I ablation had a certain predictive value for the lymph node metastasis,the number and diameter of metastases of DTC patients.sTg combined with sTg/sup-Tg ratio can improve the detection rate of metastatic lesions in DTC patients.
作者
王芳
王越
刁宏翠
王叙馥
王国强
赵文娟
Wang Fang;Wang Yue;Diao Hongcui;Wang Xufu;Wang Guoqiang;Zhao Wenjuan(Endocrinology Department,the Affilated Hospital of Qingdao University,Shandong Qingdao 266000,China;Qingdao West Coast New Area Central Hospital,Shandong Qingdao 266035,China;Nuclear Department,the Affilated Hospital of Qingdao University,Shandong Qingdao 266000,China)
出处
《现代肿瘤医学》
CAS
2020年第14期2417-2421,共5页
Journal of Modern Oncology
基金
山东省自然科学基金资助项目(编号:ZR2016HM29)。
关键词
分化型甲状腺癌
刺激性甲状腺球蛋白
淋巴结转移
differentiated thyroid carcinoma
stimulated thyroglobulin
lymph node metastasis
