高危型甲状腺乳头状癌患者在消融前刺激 TG<1ng/ml 的预后。
PROGNOSIS OF HIGH-RISK PAPILLARY THYROID CANCER PATIENTS WITH PRE-ABLATION STIMULATED TG <1 NG/ML.
出版信息
Endocr Pract. 2019 Mar;25(3):220-225. doi: 10.4158/EP-2018-0436.
OBJECTIVE
The prevalence of undetectable pre-ablation stimulated thyroglobulin (s-Tg) and its clinical implications in high-risk papillary thyroid cancer (PTC) patients remain poorly described. We investigated the rate of tumor recurrence in PTC patients initially classified as high risk but with pre-ablation s-Tg <1 ng/mL and negative anti-Tg antibody (TgAb).
METHODS
In order to have a follow-up period of at least 5 years for each patient, PTC patients consecutively seen at our department from May 2008 to June 2013 with the following characteristics were selected: (i) classified as American Thyroid Association high risk on the basis of tumor histopathologic features; (ii) submitted to adjuvant I therapy after total thyroidectomy; (iii) a postoperative pre-ablation s-Tg <1 ng/mL and negative TgAb.
RESULTS
Among 767 high-risk PTC patients submitted to adjuvant I therapy, 69 patients met the inclusion criteria. Sixty-seven patients (97.1%) were diagnosed as classical PTC, and the remaining 2 patients (2.9%) were diagnosed as follicular variant PTC. When evaluated 9 to 12 months after I therapy, 67 patients (97.1%) were classified as excellent response. Two (2.9%) patients had an s-Tg >1 ng/mL (<3 ng/mL) in the absence of apparent disease, as detected by imaging methods (indeterminate response). During a median follow-up duration of 5.6 years, recurrence was observed in only 2 (2.9%) patients. The 67 (97.1%) patients without tumor recurrence were not submitted to any additional therapy, and all had a suppressed Tg <1 ng/mL in the last assessment.
CONCLUSION
High-risk PTC patients with pre-ablation s-Tg <1 ng/mL and negative TgAb had a favorable prognosis.
ABBREVIATIONS
CT = computed tomography; L-T4 = levothyroxine; PTC = papillary thyroid cancer; SPECT/CT = single photon emission computed tomography/computed tomography; s-Tg = stimulated thyroglobulin; T4 = thyroxine; TgAb = anti-thyroglobulin antibody; US = ultrasound.
目的
术前刺激甲状腺球蛋白（s-Tg）不可检测的发生率及其在高危甲状腺乳头状癌（PTC）患者中的临床意义仍描述不足。我们研究了初始分类为高危但术前 s-Tg<1ng/ml 且抗甲状腺球蛋白抗体（TgAb）阴性的 PTC 患者的肿瘤复发率。
方法
为了使每位患者的随访时间至少为 5 年，我们选择了 2008 年 5 月至 2013 年 6 月在我科连续就诊的 PTC 患者，具有以下特征：（i）根据肿瘤组织病理学特征分类为美国甲状腺协会高危；（ii）在全甲状腺切除术后接受辅助碘治疗；（iii）术后 s-Tg<1ng/ml 且 TgAb 阴性。
结果
在 767 例接受辅助碘治疗的高危 PTC 患者中，69 例符合纳入标准。67 例（97.1%）患者诊断为经典型 PTC，其余 2 例（2.9%）患者诊断为滤泡状变异型 PTC。碘治疗后 9-12 个月评估时，67 例（97.1%）患者被分类为完全缓解。2 例（2.9%）患者 s-Tg>1ng/ml（<3ng/ml），但无明显疾病，影像学方法（不确定反应）检测到。在中位随访 5.6 年期间，仅观察到 2 例（2.9%）患者复发。67 例（97.1%）无肿瘤复发的患者未接受任何额外治疗，最后一次评估时所有患者 Tg 均被抑制<1ng/ml。
结论
术前 s-Tg<1ng/ml 且 TgAb 阴性的高危 PTC 患者预后良好。
缩写
CT=计算机断层扫描；L-T4=左旋甲状腺素；PTC=甲状腺乳头状癌；SPECT/CT=单光子发射计算机断层扫描/计算机断层扫描；s-Tg=刺激甲状腺球蛋白；T4=甲状腺素；TgAb=抗甲状腺球蛋白抗体；US=超声。
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