甲状腺乳头状癌和滤泡状癌患者术后血清甲状腺球蛋白水平的意义

Significance of postoperative serum thyroglobulin levels in patients with papillary and follicular thyroid carcinomas.

作者信息

Lin Jen-Der, Huang Miau-Ju, Hsu Brend Ray-Sea, Chao Tzu-Chieh, Hsueh Chuen, Liu Feng-Hsuan, Liou Miaw-Jene, Weng Hsiao-Fen

机构信息

Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, Republic of China.

出版信息

J Surg Oncol. 2002 May;80(1):45-51. doi: 10.1002/jso.10089.

DOI:10.1002/jso.10089

PMID:11967907

Abstract

BACKGROUND AND OBJECTIVES

Although there are many factors that affect postoperative serum levels of thyroglobulin (Tg), such levels have been previously used to detect recurrence of papillary and follicular thyroid carcinomas. This study was conducted to elucidate the significance of postoperative levels of Tg in patients with clinical presentations of papillary thyroid carcinoma, follicular thyroid carcinomas, or both.

METHODS

To collect data pertaining to patients with thyroid cancer who were treated in Chang Gung Medical Center in Linkou, Taiwan, records relating to a total of 847 patients with pathologically verified papillary or follicular thyroid cancer, all of whom received total thyroidectomy and thyroid remnant ablation with radioactive iodide ((131)I), were studied. To evaluate the clinical significance of postoperative levels of Tg, the patients were categorized into three groups based on postoperative Tg level. Group A was classified as those demonstrating a 1-month postoperative Tg levels less than 1 ng/ml. Group B patients were classified as those displaying a 1-month postoperative Tg levels greater than or equal to 1 ng/ml, but less than 10 ng/ml. Group C patients were classified as those exhibiting a 1-month postoperative Tg levels great than or equal to 10 ng/ml.

RESULTS

Of the patients in group A, none presented with distant metastases at the time of diagnosis or during the follow-up period. In group B, 15 patients (3.5%) died of thyroid cancer. In this group, tumor size was an important factor in cancer-related mortality, diagnostic clinical class, and follow-up status. Of the 491 patients in group C, 49 (10.0%) patients died of thyroid cancer. Among the patients in group C, age, histopathologic type, stage of diagnosis, and follow-up Tg values were important factors. Among groups A, B, and C, there were 161 (95.8%), 253 (76.4%), and 129 (37.1%) patients, respectively, with disease-free status at the end of 1998.

CONCLUSIONS

Postoperative serum Tg levels can be used as a prognostic indicator in patients with papillary and follicular thyroid cancer. For patients with Tg levels greater than or equal to 10 ng/ml, Tg levels are a useful marker to predict prognosis.

摘要

背景与目的

尽管有许多因素会影响术后血清甲状腺球蛋白（Tg）水平，但此前这些水平已被用于检测乳头状和滤泡状甲状腺癌的复发情况。本研究旨在阐明Tg术后水平在有乳头状甲状腺癌、滤泡状甲状腺癌或两者临床表现的患者中的意义。

方法

为收集在台湾林口长庚医学中心接受治疗的甲状腺癌患者的数据，研究了总共847例经病理证实为乳头状或滤泡状甲状腺癌的患者记录，所有患者均接受了全甲状腺切除术及用放射性碘（¹³¹I）进行甲状腺残余消融。为评估术后Tg水平的临床意义，根据术后Tg水平将患者分为三组。A组为术后1个月Tg水平低于1 ng/ml的患者。B组患者为术后1个月Tg水平大于或等于1 ng/ml但低于10 ng/ml的患者。C组患者为术后1个月Tg水平大于或等于10 ng/ml的患者。

结果

A组患者在诊断时或随访期间均无远处转移。B组中有15例患者（3.5%）死于甲状腺癌。在该组中，肿瘤大小是与癌症相关死亡率、诊断临床分级及随访状态的重要因素。C组的491例患者中，49例（10.0%）死于甲状腺癌。在C组患者中，年龄、组织病理学类型、诊断分期及随访Tg值是重要因素。在A、B、C三组中，分别有161例（95.8%）、253例（76.4%）和129例（37.1%）患者在1998年底处于无病状态。