Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China.
State Grid Information & Telecommunication Group Co., Ltd., Beijing, P.R. China.
Thyroid. 2021 Sep;31(9):1391-1399. doi: 10.1089/thy.2021.0209. Epub 2021 Aug 25.
The value of serum thyroglobulin/antithyroglobulin (Tg/antithyroglobulin antibody [ATg]) for papillary thyroid carcinoma (PTC) surveillance after lobectomy was investigated. We aimed to examine the association between postlobectomy serum Tg/ATg and PTC structural recurrence and define applicable values for stratification. PTC patients who underwent lobectomy with adequate serum Tg/ATg data during 2000-2014 were selected. Predictive classifiers of recurrence using random forest were established combining different variables related to serum Tg (ATg-negative patients) or ATg (ATg-positive patients). Cutoff values were determined with receiver operating characteristic curves when applicable. Kaplan-Meier curve and Cox regression were performed to examine the predictive value of elevated Tg/ATg. Of 1451 patients enrolled, 66 (6.3%) and 26 (6.5%) patients in the ATg-negative group ( = 1050) and ATg-positive group ( = 401) developed recurrence. The established classifier of serum Tg ( = 1050) showed a favorable association with recurrence (AUC = 0.81), while serum ATg did not (AUC = 0.72). The optimal cutoff values of the first Tg (FTg, measured 6-12 months after lobectomy) and last Tg (LTg, measured most recently) were 5.3 and 11.0 ng/mL, respectively. Elevated LTg patients had significantly higher recurrence rates than normal LTg patients (23.5% vs. 4.4%, < 0.05). Patients with elevated FTg had significantly lower recurrence-free survival rates than patients with normal FTg in all ATg-negative patients, low-risk patients, and intermediate- to high-risk patients (according to the American Thyroid Association initial risk stratification) ( = 1050, 583, and 467, all < 0.05). Multivariate analysis indicated patients with elevated FTg had twice the recurrent risk compared with those with normal FTg (hazard ratio = 2.052). Postlobectomy serum Tg has favorable value for predicting recurrence in PTC patients, and reasonable thresholds could identify patients at higher risk for recurrence during follow-up.
研究了甲状腺球蛋白/抗甲状腺球蛋白（Tg/抗甲状腺球蛋白抗体 [ATg]）在甲状腺癌术后监测中的价值。我们旨在研究术后血清 Tg/ATg 与甲状腺癌结构性复发之间的关系，并确定分层的适用值。选择了 2000 年至 2014 年间接受甲状腺叶切除术且有充足的血清 Tg/ATg 数据的甲状腺癌患者。使用随机森林结合与血清 Tg（ATg 阴性患者）或 ATg（ATg 阳性患者）相关的不同变量建立复发的预测分类器。在适用时，通过接受者操作特征曲线确定临界值。采用 Kaplan-Meier 曲线和 Cox 回归分析来检验 Tg/ATg 升高的预测价值。1451 例患者中，ATg 阴性组（=1050 例）和 ATg 阳性组（=401 例）分别有 66（6.3%）和 26（6.5%）例患者复发。血清 Tg 建立的分类器（=1050 例）与复发有良好的相关性（AUC=0.81），而血清 ATg 则没有（AUC=0.72）。甲状腺叶切除术后 6-12 个月测量的首次 Tg（FTg）和最近测量的末次 Tg（LTg）的最佳临界值分别为 5.3 和 11.0ng/mL。与 LTg 正常的患者相比，LTg 升高的患者复发率显著更高（23.5%比 4.4%，<0.05）。在所有 ATg 阴性患者、低危患者和中高危患者（根据美国甲状腺协会初始风险分层）中，FTg 升高的患者无复发生存率显著低于 FTg 正常的患者（=1050、583 和 467，均<0.05）。多变量分析表明，与 FTg 正常的患者相比，FTg 升高的患者复发风险增加一倍（风险比=2.052）。术后血清 Tg 对预测甲状腺癌患者的复发具有良好的价值，合理的阈值可以识别出随访中复发风险较高的患者。
