乳头状甲状腺癌术后复发的相关因素分析

doi:10.7538/tws.2014.27.01.0022

摘要/Abstract

摘要：

为探讨乳头状甲状腺癌术后复发的影响因素，回顾分析自2011年1月1日至2013年3月30日就诊的符合纳入标准且临床资料完整的69例乳头状甲状腺癌术后患者，男18例，女51例，平均年龄为40.17±12.97岁。所有患者均行甲状腺彩超、甲状腺功能测定、甲状腺球蛋白及抗体测定，且于未停用左旋甲状腺素状态下，甲状腺功能测定检查3次或以上，利用SPSS17.0对患者性别、年龄、肿瘤大小、手术方式、术后未停服左旋甲状腺素时促甲状腺激素（TSH）抑制程度、术后是否清甲治疗行单因素分析，多因素分析采用二分类Logistic回归分析术后复发的影响因素，绘制受试者工作特征曲线（ROC）曲线，用约登指数法确定术后TSH值评价肿瘤复发的阈值。P＜0.05为差异有统计学意义。单因素分析结果表明，乳头状甲状腺癌术后复发与年龄、手术方式无明显相关性（分别为P=0.373、P=0.226），而与性别、肿瘤大小、术后TSH抑制程度、术后是否清甲治疗相关（分别为P=0.031、P=0.004、P=0.000 01、P=0.000 05），男性、肿瘤越大、术后TSH值较高、术后未清甲治疗的复发率较高。Logistic回归分析表明，肿瘤大小、术后行TSH抑制治疗过程中TSH抑制程度及术后是否行清甲治疗是肿瘤复发的影响因素。用约登指数法，确定术后TSH抑制程度评价肿瘤复发的临界点为0.225 3 mU/L。肿瘤直径较大、术后TSH值较高、术后未行清甲治疗对肿瘤复发影响较大，为肿瘤复发的可能危险因素。

关键词: 乳头状甲状腺癌, 复发, ¹³¹I

Abstract:

To investigate the factors that influences the recurrence of papillary thyroid cancer，69 patients with papillary thyroid cancer since January 1, 2011 to march 30, 2013 were analyzed respectively. They meet the inclusion criteria and complete clinical data, 18 males and 51 females,average age: 40.17±12.97.Thyroid ultrasonography, thyroid function test, thyroglobulin and antibody measurement were performed on all patients and thyroid function were checked three or more times on the premise of continuously levothyroxine. Single factor analysis were performed using SPSS17.0 in these respects including patients' gender, age, tumor size, type of opetation, the inhibition degree of TSH with taking levothyroxine postoperative and whether to perform ¹³¹I thyroid remnant ablation. Binary Logistic regression analysis were used for studying recurrence factors in multivariate analysis. The ROC curve were drawn, and then determine the threshold of TSH to evaluate tumor recurrence using Youden index method. Unvaried analysis showed that there was no statistically significance between papillary thyroid cancer recurrence and patients' age, surgical approach (P =0.373, P = 0.226),but were related to patient's gender, tumor size, postoperative TSH suppression degree and the removal of residual thyroid tissue postoperative(P= 0.031, P = 0.004, P = 0.000 01, P = 0.000 05). Males, large tumors, high postoperative TSH values and patients who didn't remove the residual thyroid tissue after surgery had higher recurrence rate. Logistic regression analysis showed that tumor size, postoperative TSH suppression degree and whether to remove the residual thyroid tissue were the influencing factors of tumor recurrence. The postoperative TSH supressive degree evaluation of critical point of tumor recurrence was determined by 0.223 5 mU/L using the Yueden index method. Large tumors, high postoperative TSH values,and no removal of the residual thyroid tissue had more influence on tumor recurrence and were possible risk factors.

Key words: papillary thyroid cancer, recurrence, ¹³¹I

邢兰兰;陈松;李亚明. 乳头状甲状腺癌术后复发的相关因素分析[J]. 同位素, 2014, 27(1): 22-27.

XING Lan-lan;CHEN Song;LI Ya-ming. Analysis of Recurrence Factor of Postoperative Papillary Thyroid Cancer[J]. Journal of Isotopes, 2014, 27(1): 22-27.

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