Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Endocrine. 2018 Sep;61(3):506-510. doi: 10.1007/s12020-018-1643-z. Epub 2018 Jun 15.
Serum thyroglobulin (TG) is used to monitor for recurrence or progression of differentiated thyroid cancer (DTC). The role of preoperative TG measurement is more ambiguous, yet still being used in some centers. We aimed to determine whether preoperative TG correlates with disease stage or metastatic burden.
A retrospective review of patients with TG measured before thyroidectomy was conducted. Data collected included demographics, preoperative TG, pathology, and cancer stage. Associations between preoperative TG levels and size of largest malignant nodule, thyroid gland size, stage of cancer, and presence of metastasis using Wilcoxon rank sum tests and Spearman correlations were performed. Receiver operator curve (ROC) was generated for metastasis status.
Of 598 patients, we excluded those with positive TG antibodies (n = 176); 422 patients were included in the final analysis. Median age was 55 years and 76% were female. Of 78% with malignancy, papillary thyroid cancer was the most frequent (92%). 18% had TG levels >500 ng/mL and 29% <45 ng/mL. 4% had distant metastasis and 18% had lymph node metastasis. Median follow-up was 52 months. Significant positive correlations between preoperative TG and thyroid size (rho 0.49, p < 0.001), and malignant nodule size (rho 0.27, p < 0.001). Using a cut-off of 500 ng/mL, sensitivity to detect metastasis was 10.3% (95% CI 2.5-18.2), specificity 90.0% (95% CI 86.0-93.9). The area under curve for ROC (0.46, 95% CI 0.38-0.54) indicated poor diagnostic ability for metastasis.
Although preoperative TG correlated significantly with the size of the gland and T stage, there was no correlation with metastasis. Preoperative TG is of limited utility in today's value-based healthcare environment.
血清甲状腺球蛋白（TG）用于监测分化型甲状腺癌（DTC）的复发或进展。术前 TG 测量的作用较为模糊，但仍在一些中心使用。我们旨在确定术前 TG 是否与疾病分期或转移负担相关。
对术前测量 TG 的患者进行回顾性分析。收集的数据包括人口统计学资料、术前 TG、病理学和癌症分期。使用 Wilcoxon 秩和检验和 Spearman 相关分析，对术前 TG 水平与最大恶性结节大小、甲状腺大小、癌症分期和转移存在之间的相关性进行分析。绘制了转移状态的受试者工作特征曲线（ROC）。
在 598 例患者中，我们排除了 TG 抗体阳性者（n=176）；最终有 422 例患者纳入分析。中位年龄为 55 岁，76%为女性。78%的患者为恶性肿瘤，其中最常见的是甲状腺乳头状癌（92%）。18%的患者 TG 水平>500ng/ml，29%<45ng/ml。4%的患者有远处转移，18%有淋巴结转移。中位随访时间为 52 个月。术前 TG 与甲状腺大小（rho 0.49，p<0.001）和恶性结节大小（rho 0.27，p<0.001）呈显著正相关。使用 500ng/ml 的截断值，检测转移的敏感性为 10.3%（95%CI 2.5-18.2），特异性为 90.0%（95%CI 86.0-93.9）。ROC 的曲线下面积（AUC）为 0.46（95%CI 0.38-0.54），表明其对转移的诊断能力较差。
尽管术前 TG 与甲状腺大小和 T 分期显著相关，但与转移无相关性。在当前基于价值的医疗保健环境下，术前 TG 的应用价值有限。
