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投稿时间：2020-05-20 网络发布日期：2021-01-20
投稿时间：2020-05-20 网络发布日期：2021-01-20
中文摘要: 目的 分析淋巴结转移率对甲状腺乳头状癌(PTC)患者手术后碘131(131I)清除残留甲状腺组织（清甲）治疗临床转归的预测价值。
方法 采用回顾性研究方法，收集2015年1月至2017年6月收治的95例PTC患者的临床资料,手术后均行131I清甲治疗。依据患者淋巴结转移率的不同,分为A组(转移率≤ 10%)14例、B组(转移率>10%且≤ 25%)36例、C组(转移率>25%且≤ 50%)33例、D组(转移率>50%)12例。随访9~27个月,中位随访20个月,统计患者治疗后临床转归情况(满意、不确切、反应欠佳)。比较各组患者临床资料和临床转归情况,绘制受试者工作特征(ROC)曲线评价淋巴结转移率对预测临床转归为满意的最佳诊断阈值和诊断效能,通过多因素Logistic回归分析预测患者临床转归情况的独立影响因素。
结果 各组患者性别、肿瘤T分期、肿瘤部位及肿瘤直径比较,差异均无统计学意义(P均>0.05);各组年龄、病灶数量和腺外侵犯情况比较,差异有统计学意义(P均<0.01)。各组治疗后临床转归情况比较,差异有统计学意义(P<0.01)。淋巴结转移率最佳诊断阈值为52.30%,此时预测患者临床转归为满意的敏感度为53.57%,特异度达94.87%,ROC曲线下面积为0.76。年龄、多发病灶、腺外侵犯及淋巴结转移率均是预测患者临床转归情况的独立影响因素(P<0.05，P<0.01)。
结论 淋巴结转移率与PTC患者手术后131I清甲治疗的临床转归情况密切相关,随着淋巴结转移率的升高,患者临床转归情况往往较差;淋巴结转移率的最佳诊断界值为52.30%,可作为预测患者临床转归情况的独立特异性指标。
Abstract:Objective To analyze the predictive value of lymph node metastasis rate for the clinical outcome of patients with thyroid papillary carcinoma (PTC) treated after131I ablation of residual thyroid tissue treatment.
Methods The clinical data of 95 PTC patients treated with131I ablation of residual tissue after operation from January 2015 to June 2017 were collected to analyze retrospectively.
According to the different lymph node metastasis rate,the patients were divided into group A (metastasis rate ≤10%,n=14),group B (metastasis rate>10% and ≤25%,n=36),group C (metastasis rate >25% and ≤50%,n=33),group D (metastasis rate >50%,n=12).During a median follow-up of 20 months (range 9 to 27 months),the clinical outcome of the patients after treatment (satisfaction,uncertainty,poor response) was observed and compared among these groups.ROC curve was drawed and used to evaluate the best diagnostic threshold and diagnostic efficacy of lymph node metastasis rate for predicting the clinical outcome,and multivariate logistic regression analysis was used to analyze the independent influencing factor for predicting the clinical outcome of PTC patients.
Results There were no significant differences in gender,tumor stage,tumor site and tumor diameter(all P>0.05),but there were significant differences in ages,number of tumor lesions and extraglandular invasion (all P<0.01) and in the clinical outcomes among four groups(P<0.01).As the optimal diagnostic threshold of lymph node metastasis rate was 52.30%,the sensitivity,specificity and area under ROC curve were 53.57%,94.87% and 0.76,respectively.The ages,multiple foci,extraglandular invasion and lymph node metastasis rate were the independent factors influencing the clinical outcome(P<0.05,P<0.01).
Conclusions The lymph node metastasis rate is closely related to the clinical outcome of PTC patients with131I ablation of residual thyroid tissue after surgery.The increase of lymph node metastasis rate is often associated with poor clinical outcome.The optimal diagnostic threshold of lymph node metastasis rate is 52.30%,which can be used as an independent and specific index to predict the clinical outcome of PTC patients.
keywords: Papillary thyroid carcinoma Iodine-131 therapy Lymph node metastasis rate Clinical outcome Influencing factor
文章编号： 中图分类号：R736.1 文献标志码：B
基金项目:湖北省自然科学基金项目(2017CFC042)
| 作者 | 单位 |
| 刘云 1 | 1.华中科技大学同济医学院附属同济医院耳鼻喉科,湖北 武汉 430030； |
| 程腾 2 | 2.华中科技大学同济医学院附属同济医院甲乳外科,湖北 武汉 430030； |
| 徐涛 2 | 2.华中科技大学同济医学院附属同济医院甲乳外科,湖北 武汉 430030； |
| 夏文飞2 | 2.华中科技大学同济医学院附属同济医院甲乳外科,湖北 武汉 430030； |
引用文本：
刘云 ,程腾 ,徐涛 ,等.淋巴结转移率对甲状腺乳头状癌术后131I治疗临床转归的预测价值[J].中国临床研究,2021,34(1):52-55.
刘云 ,程腾 ,徐涛 ,等.淋巴结转移率对甲状腺乳头状癌术后131I治疗临床转归的预测价值[J].中国临床研究,2021,34(1):52-55.