分化型甲状腺癌患者甲状腺球蛋白升高的长期后果。
Long-term consequence of elevated thyroglobulin in differentiated thyroid cancer.
机构信息
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
出版信息
Thyroid. 2013 Jan;23(1):58-63. doi: 10.1089/thy.2011.0487.
BACKGROUND
Serum thyroglobulin (Tg) is the most sensitive biomarker for recurrence of differentiated thyroid cancer (DTC). We have assessed the changing pattern of stimulated Tg (sTg) and the clinical course of patients with no structural evidence of disease (NSED), based on imaging studies such as neck ultrasonography (US), fluorodeoxyglucose positron emission tomography, and/or chest computed tomogram (CT). We sought to determine if, in patients with DTC who had been treated with bilateral thyroidectomy and remnant ablation with radioactive iodine, sTg 1 year (sTg1) after initial treatment and repeated sTg measurements, 1-2 years after sTg1, helped predict the long-term outcome with respect to structural recurrence and biochemical remission (BR), which is defined as sTg <1 ng/mL.
METHODS
We retrospectively assessed the records of patients with DTC who had been treated with bilateral thyroidectomy and remnant ablation with radioactive iodine between 1995 and 2004. The study included 186 patients who had NSED with sTg1 ≥2 ng/mL and subsequent sTg measurements (sTg2) without additional treatment. Patients were classified into three groups based on their sTg1 measurements: Group A, 2-4.9 ng/mL; Group B, 5-19.9 ng/mL; and Group C, ≥20 ng/mL. Patients were also classified into two groups based on whether sTg2, 1-2 years after sTg1, had decreased by ≥50% (Group 1) or had either decreased by <50% or increased (Group 2). sTg was measured every 1-2 years until structural recurrence or BR.
RESULTS
Patients remaining in NSED showed a decrease in serial sTg. Of patients in Groups A, B, and C, 41%, 17%, and 1%, respectively, achieved BR, and there was a significant difference in the BR rate between Groups 1 and 2 (p<0.001). In patients with structural recurrence, serial sTg generally did not decrease from sTg1. There was a significant difference in the recurrence rate among Groups A, B, and C (p=0.005) and between Groups 1 and 2 (p<0.001).
CONCLUSIONS
We found that 41% of patients with sTg1 in the range 2-5 ng/mL achieved BR, and that sTg1 and percent change of subsequent sTg were predictive of BR. Repeated sTg measurements are useful for predicting patient prognosis in patients with DTC.
背景
血清甲状腺球蛋白（Tg）是分化型甲状腺癌（DTC）复发的最敏感生物标志物。我们评估了在没有结构疾病证据（NSED）的情况下，基于颈部超声（US）、氟脱氧葡萄糖正电子发射断层扫描和/或胸部计算机断层扫描（CT）等影像学研究，刺激 Tg（sTg）的变化模式和患者的临床过程。我们试图确定在接受双侧甲状腺切除术和放射性碘残留消融治疗的 DTC 患者中，初始治疗后 1 年（sTg1）的 sTg 和 1-2 年后的重复 sTg 测量是否有助于预测结构复发和生化缓解（BR）的长期结果，BR 定义为 sTg <1ng/mL。
方法
我们回顾性评估了 1995 年至 2004 年间接受双侧甲状腺切除术和放射性碘残留消融治疗的 DTC 患者的记录。该研究包括 186 例 sTg1≥2ng/mL 且随后 sTg 测量（sTg2）无额外治疗的 NSED 患者。根据 sTg1 测量值将患者分为三组：A 组，2-4.9ng/mL；B 组，5-19.9ng/mL；C 组，≥20ng/mL。根据 sTg1 后 1-2 年 sTg2 是否降低≥50%（第 1 组）或降低<50%或升高（第 2 组），患者也分为两组。sTg 每 1-2 年测量一次，直到出现结构复发或 BR。
结果
仍处于 NSED 的患者 sTg 呈连续下降。A、B 和 C 组中分别有 41%、17%和 1%的患者达到 BR，组 1 和组 2 之间的 BR 率存在显著差异（p<0.001）。在发生结构复发的患者中，sTg1 后的 sTg 通常不会下降。A、B 和 C 组之间（p=0.005）和组 1 和组 2 之间（p<0.001）的复发率存在显著差异。
结论
我们发现，sTg1 在 2-5ng/mL 范围内的患者中有 41%达到 BR，sTg1 和随后 sTg 的百分比变化可预测 BR。重复 sTg 测量有助于预测 DTC 患者的预后。
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