血清甲状腺球蛋白水平对术后分化型甲状腺癌患者预后的临床意义

摘要

Objective To evaluate the clinical significance of serum thyroglobulin ( Tg) on the prognosis of differentiated thyroid cancer( DTC) patients.Methods Fifty-seven patients with DTC who had been trea-ted with thyroidectomy between Jan.2007 and Jan.2010 in Yankuang Group General Hospital Jidong Branch were enrolled in this study.The quantitative determination of Tg and thyroglobulin antibody ( TgAb) serum levels were performed at the twelve months after surgery by electrochemiluminescence immunoassay method . The feasibility of serum Tg in determining lymph node metastasis was analyzed by receiver operating charac-teristic( ROC) curve,and Kaplan-Meier method was used to evaluate progression free survival to evaluate the clinical significance of postoperative Tg level for prediction of the prognosis of the patients .Results The one year postoperative serum level of Tg was higher in DTC patients with lymphaticmetastasis than those without lymphaticmetastasis[(38.5 ±8.4) μg/L vs (9.1 ±2.8) μg/L](P <0.01),and serum level of Tg was higher in DTC patients with distant metastasis than those without distant metastasis[(39.3 ±7.2) μg/L vs (19.0 ±4.8)μg/L] (P <0.05).The ROC curve analysis showed an area under the curve of 0.773 (95% CI 0.649-0.896,P<0.05),with a specificity of 84.0% and a sensitivity of 84.8% at cut off value of 14.5 μg/L.There was difference in progression free survival time between >14.5 μg/L and <14.5 μg/L patients with DTC(P=0.01).Conclusion The serum Tg levels after surgery in DTC patients is expected to be used as a prognostic indicator for metastasis of DTC .%目的：探讨血清中甲状腺球蛋白（ Tg）对分化型甲状腺癌（ DTC）患者预后的临床意义。方法纳入2007年1月至2010年1月在兖矿集团有限公司总医院首次确诊并经甲状腺全切术的分化型甲状腺癌患者57例，术后12个月采用电化学发光免疫分析法分别测定Tg、甲状腺球蛋白抗体（ TgAb）水平，通过受试者工作特征（ ROC）曲线分析血清Tg用于判断甲状腺癌患者是否发生淋巴结转移的可行性，Kaplan-Meier法进行生存分析，评价术后 Tg用于预测患者预后的临床意义。结果术后1年，有淋巴结转移患者的 Tg 水平高于无淋巴结转移患者[（38.5±8.4）μg／L 比（9.1±2.8）μg／L]（P＜0.01），有远处转移患者Tg水平高于无远处转移患者[（39.3±7.2）μg／L 比（19.0±4.8）μg／L]（P＜0.01）。绘制ROC曲线，血清Tg用于诊断DTC患者发生淋巴结转移的曲线下面积为0.773（95％ CI 0.649～0.896，P＜0.05），通过最佳切点值分析得到 Tg的临界值为14.5μg／L时，其诊断的灵敏度为84.8％，特异度为84.0％。 Tg水平＞14.5μg／L的患者和＜14.5μg／L的患者的无进展生存时间差异有统计学意义（ P＝0.01）。结论 DTC 患者术后 Tg水平有望成为预测DTC患者转移等预后的指标。