摘要
Abstract
Objective To explore the factors influencing the efficacy of postoperative first 131I therapy in patients with papillary thy-roid carcinoma(PTC)with cervical lymph node metastases detected by iodine and low stimulated thyroglobulin(sTg)level(sTg<10 μg/L).Methods Retrospective analysis of 98 postoperative PTC patients with low sTg level and no distant metastases at the time of their first 131I treatment at Hangzhou Cancer Hospital between July 2014 and April 2021 was conducted.According to the post-treatment whole body scan(Rx-WBS)results,the patients were divided into two groups:a group with cervical lymph node metastasis detected by iodine(LN+,n=53)and a group without cervical lymph node metastasis detected by iodine(LN-,n=45).Efficacy evaluation was performed 6 months after 131I treatment by determining whether excellent response(ER)was achieved based on sTg levels and the results of diagnostic whole body scan(Dx-WBS)and other imaging tests.The LN+and LN-groups were compared in terms of age,sex,sTg level,anti-thyroglobulin antibody(TgAb)level,ER rate,T stage,N stage,the number of lymph node metastases in pathology,and the dose of 131I treatment.Uni-variate and multivariate logistic analyses were performed to find the factors affecting the efficacy of the treatment.The predictive value and optimal diagnostic thresholds of these factors were assessed by receiver operating characteristic(ROC)curves.Results Between the LN+and LN-groups,there were significant differences in ER rate 6 months after the first 131I treatment,sTg level,and the number of lymph node metastases in pathology(all P<0.05),and no significant differences in age,sex,T stage,N stage,TgAb level,and 131I treatment dose(all P>0.05).Univariate logistic regression analysis showed that patients'sTg level and the number of lymph node metastases in pathology were associated with the efficacy of 131I treatment(both P<0.05).Multivariate analysis showed that sTg level was a determinant factor influencing the efficacy of 131I treatment(P<0.05).The area under the ROC curve for pretreatment sTg level predicting ER was 0.799(95%CI:0.708-0.889).The sensitivity and specificity of predicting ER at the cutoff value of sTg level which was 2.655 μg/L were 69.2%and 77.8%,re-spectively.Conclusions In postoperative PTC patients with low sTg level accompanied by cervical lymph node metastases detected by iodine,the short-term efficacy of 131I therapy is overall inferior to that in those without cervical lymph node metastases detected by iodine.sTg level is an independent risk factor affecting the prognosis of 131I therapy in this group of patients,and those with low sTg level have a higher likelihood of achieving a satisfactory outcome after 131I therapy.关键词
甲状腺乳头状癌/甲状腺球蛋白/颈部摄碘淋巴结转移/预后Key words
papillary thyroid carcinoma/thyroglobulin/cervical lymph node metastasis detected by iodine/prognosis
