Heemstra Karen A, Liu Ying Y, Stokkel Marcel, Kievit Job, Corssmit Eleonora, Pereira Alberto M, Romijn Johannes A, Smit Johannes W A
Department of Endocrinology and Metabolic Diseases, Leiden University Medical Centre, leiden, The Netherlands.
Clin Endocrinol (Oxf). 2007 Jan;66(1):58-64. doi: 10.1111/j.1365-2265.2006.02685.x.
Most studies on the diagnostic value of serum thyroglobulin (Tg) concentrations in differentiated thyroid carcinoma (DTC) use fixed cut-off levels in heterogeneous groups of patients with respect to initial therapy and do not provide prognostic data. The objective was to investigate the prognostic values of serum Tg for disease-free remission and death, measured at fixed time-points after initial therapy using receiver operator characteristic (ROC) curve analyses.
Single-centre observational study with 366 consecutive patients with DTC, who had all been treated according to the same protocol for initial therapy and follow-up.
Tg concentrations were measured at five fixed time-points after initial surgery. Tg cut-off values with the highest accuracy were calculated with ROC analyses.
During the 8.3 +/- 4.6 years of follow-up, 84% of the patients were cured. Pre-ablative Tg levels were an independent prognostic indicator for disease-free remission (Tg cut-off value 27.5 microg/l, positive predictive value 98%). The highest diagnostic accuracies of serum Tg for tumour presence were found during TSH-stimulated Tg measurements, 6 months after initial therapy (Tg cut-off value 10 microg/l; sensitivity 100%, specificity 93%). DTC-related mortality was 14%. TSH-stimulated Tg levels before ablation and 6 months after initial therapy were independent prognostic indicators for death.
Optimal institutional Tg cut-off levels for diagnosis and prognosis should be defined using ROC analyses for each condition and time-point. Tg measurements 6 months after initial therapy during TSH stimulation had an excellent diagnostic value. Tg levels are independent prognostic indicators for disease-free remission and death. Using this strategy, high-risk patient groups can be selected based on Tg levels, in addition to conventionally used prognostic indicators.
大多数关于血清甲状腺球蛋白（Tg）浓度在分化型甲状腺癌（DTC）诊断价值的研究，在初始治疗方面，针对异质性患者群体使用固定的临界值，且未提供预后数据。本研究目的是通过受试者操作特征（ROC）曲线分析，调查初始治疗后固定时间点测量的血清Tg对无病缓解和死亡的预后价值。
对366例连续的DTC患者进行单中心观察性研究，所有患者均按照相同方案进行初始治疗和随访。
在初次手术后的五个固定时间点测量Tg浓度。通过ROC分析计算出准确性最高的Tg临界值。
在8.3±4.6年的随访期间，84%的患者治愈。消融前Tg水平是无病缓解的独立预后指标（Tg临界值27.5μg/L，阳性预测值98%）。在初始治疗后6个月促甲状腺激素（TSH）刺激下测量Tg时，血清Tg对肿瘤存在的诊断准确性最高（Tg临界值10μg/L；敏感性100%，特异性93%）。DTC相关死亡率为14%。消融前及初始治疗后6个月的TSH刺激下Tg水平是死亡的独立预后指标。
应针对每种情况和时间点，通过ROC分析确定用于诊断和预后的最佳机构内Tg临界值。初始治疗后6个月TSH刺激下的Tg测量具有出色的诊断价值。Tg水平是无病缓解和死亡的独立预后指标。采用该策略，除了传统使用的预后指标外，还可根据Tg水平选择高危患者群体。
