Tianjin Medical University General Hospital, Tianjin, China.
Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
Front Endocrinol (Lausanne). 2022 Jun 28;13:930180. doi: 10.3389/fendo.2022.930180. eCollection 2022.
To assess predictive value of clinical and pathological characteristics for metastatic radioactive iodine-refractory differentiated thyroid carcinoma (RAIR-DTC) in early stage retrospectively.
We studied 199 metastatic DTC patients who were divided into two groups (TgAb negative and TgAb positive). The stimulated Tg (Sti-Tg) at the first and second radioiodine therapy (RIT) were defined as Sti-Tg1 and Sti-Tg2, the suppressed Tg (Sup-Tg) were designated as Sup-Tg1 and Sup-Tg2, while the TgAb were defined as TgAb1 and TgAb2, respectively. Univariate analysis and Logistic regression were used to investigate the effects of 13 observed factors to predict RAIR-DTC.
In TgAb negative group, ROC curve analysis showed that cut-off values of age, Sti-Tg2/Sti-Tg1 and Sup-Tg2/Sup-Tg1 to predict RAIR-DTC were 40 years old, 57.0% and 81.0%, respectively. Age, extrathyroid invasion, Sti-Tg2/Sti-Tg1, Sup-Tg2/Sup-Tg1 and BRAF gene mutation were proved to be independent factors predicting RAIR-DTC. In TgAb-positive group, ROC curve analysis showed that cut-off values of age, TgAb1 and TgAb2/TgAb1 to predict RAIR-DTC were 55 years old, 297 IU/ml (14.8 times higher than the upper limit) and 53.6%, respectively.
For TgAb-negative DTC, age over 40, extraglandular invasion, mutated BRAF gene, Sti-Tg decreased less than 43%, and Sup-Tg decreased less than 19% after the first two courses of RIT were independent predictors for RAIR-DTC. For TgAb-positive DTC, age over 55, extraglandular invasion, mutated BRAF gene, distant metastasis before RIT, TgAb level 14.8 times higher than the upper limit, TgAb dropped less than 46.4% after two courses of RIT were influencing factors.
回顾性评估临床和病理特征对早期放射性碘难治性分化型甲状腺癌（RAIR-DTC）转移的预测价值。
我们研究了 199 例转移性 DTC 患者，将其分为两组（TgAb 阴性和 TgAb 阳性）。第一次和第二次放射性碘治疗（RIT）时的刺激甲状腺球蛋白（Sti-Tg）定义为 Sti-Tg1 和 Sti-Tg2，抑制甲状腺球蛋白（Sup-Tg）分别指定为 Sup-Tg1 和 Sup-Tg2，而 TgAb 分别定义为 TgAb1 和 TgAb2。采用单因素分析和 Logistic 回归分析探讨 13 种观察因素对预测 RAIR-DTC 的影响。
在 TgAb 阴性组中，ROC 曲线分析显示，预测 RAIR-DTC 的年龄、Sti-Tg2/Sti-Tg1 和 Sup-Tg2/Sup-Tg1 的截断值分别为 40 岁、57.0%和 81.0%。年龄、甲状腺外侵犯、Sti-Tg2/Sti-Tg1、Sup-Tg2/Sup-Tg1 和 BRAF 基因突变被证明是预测 RAIR-DTC 的独立因素。在 TgAb 阳性组中，ROC 曲线分析显示，预测 RAIR-DTC 的年龄、TgAb1 和 TgAb2/TgAb1 的截断值分别为 55 岁、297 IU/ml（比上限高 14.8 倍）和 53.6%。
对于 TgAb 阴性 DTC，年龄>40 岁、甲状腺外侵犯、BRAF 基因突变、Sti-Tg 减少<43%、前两周期 RIT 后 Sup-Tg 减少<19%是 RAIR-DTC 的独立预测因素。对于 TgAb 阳性 DTC，年龄>55 岁、甲状腺外侵犯、BRAF 基因突变、RIT 前远处转移、TgAb 水平比上限高 14.8 倍、RIT 后两个周期 TgAb 下降<46.4%是影响因素。
