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甲状腺乳头状癌全甲状腺切除术后甲状腺球蛋白血症的预测因素

Predictive Factors of Athyroglobulinemia After Total Thyroidectomy for Papillary Thyroid Cancer.

作者信息

Fernández-Baeza Marta, Muñoz-Pérez Nuria V, Roldán-Ortiz Ignacio, Alonso-Sebastián María J, Carbajo-Barbosa Francisco M, Rejón-López Rafael, Olvera-Porcel María C, Becerra-Massare Antonio, Arcelus-Martínez Juan I, Villar-Del-Moral Jesús María

机构信息

Endocrine Surgery Unit, General Surgery Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain.

Medical School, University of Granada, 18071 Granada, Spain.

出版信息

Cancers (Basel). 2024 Dec 11;16(24):4129. doi: 10.3390/cancers16244129.

DOI:10.3390/cancers16244129
PMID:39766029
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11674440/
Abstract

: Thyroglobulin (Tg) is the specific tumor marker for epithelial thyroid cancer. It holds significant value in the postoperative period, and somehow, the goal of surgery in papillary thyroid cancer (PTC) undergoing total thyroidectomy is to achieve undetectable levels of postoperative thyroglobulin (uTg). : This is a retrospective single-center study in which first basal Tg values were evaluated post-surgery in PTC patients undergoing total thyroidectomy. Patients with elevated antithyroglobulin antibodies were excluded. The impact of various demographic, clinical, therapeutic, tumor-stage related, and histopathological variables on the achievement of undetectable thyroglobulin levels (uTg, <1 ng/mL) was studied. A descriptive and logistic regression-based bivariate and multivariate analysis was planned using STATA vs. 16.1. program. The significance level was stated at 0.05. : Basal athyroglobulinemia was obtained in 89.6% of 202 patients operated on between January 2015 and June 2023 in a single referral institution. Due to the limited number of cases with detectable Tg, multivariate analysis could not be performed. The main factors that favored its achievement on bivariate analysis were a smaller tumor size ( = 0.003), no need for extended resections due to local invasion beyond the thyroid gland ( = 0.003) or neck dissection ( = 0.039), absence of distant metastases ( = 0.000), and a lower MACIS score ( < 0.000). : The achievement of uTg was closely related to factors related to tumor stage (tumor diameter, lymph node spread, and metastatic disease), and it was not influenced by differences in epidemiological data, clinic manifestations, preoperative diagnosis, multifocality, or the presence of aggressive cytological variants.

摘要

甲状腺球蛋白(Tg)是甲状腺上皮癌的特异性肿瘤标志物。它在术后阶段具有重要价值,在某种程度上,接受全甲状腺切除术的乳头状甲状腺癌(PTC)手术的目标是使术后甲状腺球蛋白(uTg)水平检测不到。

这是一项回顾性单中心研究,对接受全甲状腺切除术的PTC患者术后首次基础Tg值进行评估。排除抗甲状腺球蛋白抗体升高的患者。研究了各种人口统计学、临床、治疗、肿瘤分期相关和组织病理学变量对实现不可检测甲状腺球蛋白水平(uTg,<1 ng/mL)的影响。计划使用STATA 16.1程序进行基于描述性和逻辑回归的双变量和多变量分析。显著性水平设定为0.05。

在2015年1月至2023年6月期间,在一家单一转诊机构接受手术的202例患者中,89.6%实现了基础无甲状腺球蛋白血症。由于可检测到Tg的病例数量有限,无法进行多变量分析。双变量分析中有利于实现这一目标的主要因素是肿瘤较小(P = 0.003)、无需因甲状腺外局部侵犯(P = 0.003)或颈部清扫(P = 0.039)而进行扩大切除、无远处转移(P = 0.000)以及MACIS评分较低(P < 0.000)。

uTg的实现与肿瘤分期相关因素(肿瘤直径、淋巴结转移和转移性疾病)密切相关,不受流行病学数据、临床表现、术前诊断、多灶性或侵袭性细胞学变异的存在差异的影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8ec/11674440/86b9de70e81d/cancers-16-04129-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8ec/11674440/86b9de70e81d/cancers-16-04129-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8ec/11674440/86b9de70e81d/cancers-16-04129-g001.jpg

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