术前血清甲状腺球蛋白和降钙素水平对微波消融治疗复发性甲状腺癌预后的影响-现代医学

术前血清甲状腺球蛋白和降钙素水平对微波消融治疗复发性甲状腺癌预后的影响

单位：1. 上海沪东医院超声科, 上海 200129;
2. 上海交通大学医学院附属瑞金医院卢湾分院超声科, 上海 200129;
3. 同济大学附属东方医院超声科, 上海 200120

分类号：R736.1

出版年·卷·期（页码）：2018·46·第四期（365-370）

摘要：

目的：探讨术前血清甲状腺球蛋白（TG）和降钙素（CT）水平对微波消融治疗复发性甲状腺癌预后的影响。方法：选择在上海沪东医院行微波消融治疗并有随访资料的112例复发性甲状腺癌患者，比较生存组和死亡组术前及随访资料，分析微波消融前TG和CT水平对患者术后生存率的影响。结果：死亡组患者术前血清TG水平、CT水平、复发病灶直径、半乳糖凝集素-3及血管内皮生长因子水平均高于或长于生存组（P<0.05）。术前血清TG水平[风险比（HR）为2.832， 95%CI为3.691～13.263， P=0.012]、CT水平（HR为2.443， 95%CI为1.565～7.902， P=0.028）与微波消融后生存期密切相关，是预后的独立影响因素。术前血清TG水平正常（<60 μg·L^-1）与异常（≥60 μg·L^-1）者的1、2、5年累计生存率分别为0.904、0.826、0.317与0.783、0.543、0.194，CT水平正常（<100 ng·L^-1）与异常（≥100 ng·L^-1）者的1、2、5年累计生存率分别为0.875、0.738、0.336与0.812、0.558、0.169，差异均具有统计学意义（P<0.05）。结论：复发性甲状腺癌患者微波消融术前血清TG和CT水平对预后有一定的预测价值，控制两指标对患者的长期生存具有一定的临床意义。

Objective: To investigate the effect of preoperative serum thyroglobulin(TG) and calcitonin(CT) on the prognosis of recurrent thyroid cancer treated with microwave ablation. Methods: Totally 112 patients with recurrent thyroid cancer who underwent microwave ablation in Shanghai Hudong Hospital were involved and followed up. Preoperative and follow-up data of survival group and death group were compared, and the effect of TG and CT levels before microwave ablation on the postoperative survival rate of patients with recurrent thyroid cancer was analyzed. Results: Preoperative serum TG, CT, diameter of recurrent lesion, galectin-3, and vascular endothelial growth factor were significantly higher in the death group than those in the survival group(P<0.05). Preoperative serum TG(HR=2.832, 95%CI:3.691-13.263, P=0.012), CT(HR=2.443, 95%CI:1.565-7.902, P=0.028) was closely related to survival after microwave ablation of recurrent thyroid cancer and was an independent prognostic factor. The 1-, 2- and 5- year cumulative survival rates of patients with normal preoperative serum TG(<60 μg·L^-1) and abnormal levels(≥ 60 μg·L^-1) were 0.904, 0.826, 0.317 and 0.783, 0.543, 0.194, respectively. The 1-, 2- and 5- year cumulative survival rates of patients with normal CT(<100 ng·L^-1) and abnormal CT levels(≥ 100 ng·L^-1) were 0.875, 0.738, 0.336 and 0.812, 0.558, 0.169, respectively. All the differences were statistically significant(P<0.05). Conclusion: The levels of serum TG and CT before microwave ablation in patients with recurrent thyroid cancer have some predictive value in the prognosis, and it is of clinical significance to control the two indexes for long-term survival of patients with recurrent thyroid cancer.

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