Predictive value for disease progression of serum thyroglobulin levels measured in the postoperative period and after (131)I ablation therapy in patients with differentiated thyroid cancer.
Predictive value for disease progression of serum thyroglobulin levels measured in the postoperative period and after (131)I ablation therapy in patients with differentiated thyroid cancer.
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发表时间：
2004-06
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通讯作者：
M. Toubeau;C. Touzery;P. Arveux;G. Chaplain;G. Vaillant;A. Berriolo;J. Riedinger;C. Boichot;
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作者：
M. Toubeau;C. Touzery;P. Arveux;G. Chaplain;G. Vaillant;A. Berriolo;J. Riedinger;C. Boichot;
我们研究的目的是评估和比较甲状腺癌患者在促甲状腺激素 (TSH) 刺激下、术后 (131)I 消融治疗前和 6-12 个月后控制时测量的甲状腺球蛋白 (Tg) 水平对疾病进展的预测价值。方法 对 212 名连续接受治疗且无初始远处转移的高分化甲状腺癌患者（184 例乳头状癌，28 例滤泡状癌）进行回顾性研究。所有患者均接受了甲状腺全切除术或近全甲状腺切除术，随后进行了 3.7 GBq (131)I 消融。 Tg 水平在消融治疗前 (Tg1) 和 6-12 个月后 (Tg2) 测定。 Tg1 和 Tg2 的阈值分别为 30 ng/mL 和 10 ng/mL。进行单变量和多变量分析以评估 2 个 Tg 测定对疾病进展的预测价值。结果 30 名患者的 Tg1 水平 > 30 ng/mL。 6 至 12 个月后，30 名患者的 Tg2 水平 > 10 ng/mL，其中 19 名患者最初的 Tg1 水平 > 30 ng/mL。 20 名患者 (9%) 报告疾病进展。 Tg1 或 Tg2 水平较低的患者的无进展生存率显着较低，但 Tg2 水平的差异更为重要。通过单变量分析，5 个变量与疾病进展显着相关：Tg2、Tg1、淋巴结侵犯、甲状腺外扩展和肿瘤大小。通过多变量分析，只有 Tg2（比值比 [OR] = 16.4；95% 置信区间 [95% CI] = 5.7-47.4；P < 0.001）和淋巴结侵袭（OR = 2.7；95% CI = 1.0-7.2；P = 0.04）具有独立的预后价值。当仅考虑初始参数时，Tg1 和淋巴结侵袭是 2 个独立的预后因素。 Tg1 的 OR 降低（OR = 10.1；95% CI = 4.0-25.7；P < 0.001），但淋巴结侵袭则增加（OR = 4.4；95% CI = 1.7-11.2；P = 0.002）。结论 在所有临床和肿瘤变量中，淋巴结侵犯和血清 Tg 水平是定义疾病进展风险的两个重要参数。尽管 Tg2 看起来比 Tg1 更显着，但在 TSH 刺激下、术后期间和消融治疗后几个月测量的 Tg 水平都具有预测价值。在临床实践中，一旦知道初始淋巴结状态和 Tg1 水平，就可以选择处于危险中的患者。
UNLABELLED The aim of our study was to evaluate and compare in thyroid cancer patients the predictive value for disease progression of thyroglobulin (Tg) levels measured under thyroid-stimulating hormone (TSH) stimulation, in the postoperative period just before (131)I ablative therapy and at the time of control 6-12 mo later. METHODS Two-hundred twelve consecutive patients treated for a well-differentiated thyroid carcinoma (184 papillary, 28 follicular) with no initial distant metastases were retrospectively studied. All patients had a total or near-total thyroidectomy followed by ablation with 3.7 GBq (131)I. Tg levels were determined just before ablative therapy (Tg1) and 6-12 mo later (Tg2). Thresholds of 30 and 10 ng/mL were used for Tg1 and Tg2, respectively. Univariate and multivariate analyses were performed to assess the predictive value for disease progression of the 2 Tg determinations. RESULTS Thirty patients had a Tg1 level > 30 ng/mL. Six to 12 mo later, 30 patients had a Tg2 level > 10 ng/mL, 19 of whom had initially a Tg1 level > 30 ng/mL. Disease progression was reported in 20 patients (9%). Progression-free survival rates were significantly lower in patients with a low Tg1 or Tg2 level but the difference was more important with Tg2. With univariate analysis, 5 variables were significantly associated with disease progression: Tg2, Tg1, node invasion, extrathyroidal extension, and tumor size. With multivariate analysis, only Tg2 (odds ratio [OR] = 16.4; 95% confidence interval [95% CI] = 5.7-47.4; P < 0.001) and node invasion (OR = 2.7; 95% CI = 1.0-7.2; P = 0.04) had an independent prognostic value. When only initial parameters were considered, Tg1 and node invasion were the 2 independent prognostic factors. The OR decreased for Tg1 (OR = 10.1; 95% CI = 4.0-25.7; P < 0.001) but increased for node invasion (OR = 4.4; 95% CI = 1.7-11.2; P = 0.002). CONCLUSION Among all clinical and tumoral variables, lymph node invasion and serum Tg level are 2 important parameters to define the risk of disease progression. Although Tg2 appears more significant than Tg1, both Tg levels measured under TSH stimulation, in the postoperative period and a few months after ablative therapy, have a predictive value. In clinical practice, patients at risk can be selected as soon as the initial lymph node status and Tg1 level are known.