摘要
目的评价PTC患者术后首次^131I治疗疗效的影响因素。方法回顾性分析2014年7月至2015年12月间接受首次^131I治疗的159例PTC甲状腺全切术后患者[男45例，女114例，年龄（43.4±12.2）岁]，在治疗后6个月进行疗效评价。结合TSH刺激状态的Tg水平、Dx－WBS和其他影像学检查等判断是否达到临床治愈。对可能影响疗效的年龄、性别、^131I治疗与手术的时间间隔、肿瘤原发灶大小及甲状腺外侵犯情况、原发病灶数目及范围、淋巴结转移、^99Tc^mO4-甲状腺显像所示残留甲状腺组织（简称残甲）状态、治疗前TSH、刺激性Tg（sTg）、TgAb、^131I治疗剂量、^131I治疗后全身显像和SPECT显像所见等12个因素进行单因素及多因素logistic分析。通过ROC曲线及最佳诊断界值评价影响因素对治疗结局的预测价值。结果PTC患者术后首次^131I治疗的临床治愈率为64.2%（102/159）。单因素logistic回归分析结果显示，患者年龄、性别、淋巴结转移情况、sTg及^131I治疗剂量5个因素与PTC患者术后首次^131I治疗疗效有关（均P〈0.01）；多因素分析结果显示，淋巴结转移情况（回归系数1.118）及sTg（回归系数0.314）是影响^131I治疗疗效的确定性因素（均P〈0.05）。回归方程为Logit P＝－4.155＋1.118×淋巴结转移情况＋0.314×sTg（χ^2＝93.7, P〈0.001）。治疗前sTg的ROC AUC为0.926（95% CI：0.888～0.963）。sTg界值点为2.97 μg/L，对应的灵敏度、特异性分别为94.7%（54/57）和76.5%（78/102）。结论PTC术后sTg低、淋巴结转移程度轻的患者在首次131I治疗中更可能获得临床治愈。
ObjectiveTo investigate the influential factors for the outcome of the first ^131I therapy in patients with PTC after total thyroidectomy.MethodsOne hundred and fifty-nine patients （45 males, 114 females, average age （43.4±12.2） years） with PTC after total thyroidectomy who underwent ^131I therapy from July 2014 to December 2015 were retrospectively analyzed. Curative efficacy was evaluated 6 months after ^131I therapy. Therapeutic outcome was evaluated according to TSH stimulated Tg （sTg） level, Dx-WBS and evidences of other imaging modalities. Twelve possible factors affecting therapeutic outcome of ^131I therapy, including patients′ age, gender, time interval between thyroidectomy and ^131I therapy, primary tumors size and extrathyroidal extension, number and range of primary tumor lesions, lymph node metastases in surgery, status of thyroid remnant in ^99Tc^mO4^- imaging, pre-treatment laboratory measurements （TSH, sTg and TgAb）, ^131I therapeutic dose, results of Rx-WBS and SPECT after 131I therapy, were analyzed with univariate and multivariate logistic regression. ROC curve and diagnostic critical point were analyzed to evaluate the predictive value of influential factors for the outcome of ^131I therapy.ResultsThe cure rate of the first 131I therapy was 64.2%（102/159）. Univariate logistic regression analysis showed that age, gender, lymph node metastases, sTg and ^131I therapeutic dose （all P〈0.01） were the influential factors for the outcome of 131I therapy. Multivariate logistic regression analysis showed that lymph node metastases （regression coefficient： 1.118） and sTg （regression coefficient： 0.314） were influential factors （both P〈0.05）. The regression equation was： Logit P=-4.155＋ 1.118×lymph node metastases＋ 0.314×sTg （χ^2=93.7, P〈0.001）. Taking sTg as a predictive factor for the outcome of ^131I therapy, the AUC of ROC curve was 0.926 （95% CI： 0.888-0.963）. The cut-off value of sTg was 2.97 μg/L with a sensitivity of 94.7%（54/
出处
《中华核医学与分子影像杂志》
北大核心
2017年第12期777-782,共6页
Chinese Journal of Nuclear Medicine and Molecular Imaging
基金
杭州市重大科技创新专项项目（20131813A08）
