Analysis of risk factors for recurrence of differentiated thyroid carcinoma after surgical resection combined with iodine-131 and TSH suppression therapy
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摘要: 目的 探讨分化型甲状腺癌(differentiated thyroid cancer，DTC)外科切除联合碘-131(131I)及促甲状腺激素(thyroid stimulating hormone，TSH)抑制治疗后复发的危险因素。方法 回顾性分析2015年1月-2020年4月解放军总医院第一医学中心接受外科手术联合131I及TSH抑制治疗后，随访发生结构性复发和未复发患者的临床资料。分析比较两组患者的一般情况，符合正态分布的计量资料，组间比较采用t检验；非正态分布的计量资料，组间比较采用秩和检验；计数资料组间比较采用χ2检验。采用单变量和多变量回归分析确定与复发相关的危险因素。结果 中位随访周期为43个月(18~81个月)，955例患者中，复发100例(10.5%)。单因素分析显示，肿瘤大小、肿瘤多发、颈部中央区淋巴结转移数>5个、颈侧区淋巴结转移数>5个与治疗后复发显著相关(P < 0.001、P=0.018、P < 0.001、P < 0.001)。多变量分析显示，肿瘤大小(调整后的比值比OR：1.496，95%CI：1.226~1.826，P < 0.001)、肿瘤多发(调整后的比值比OR：1.927，95%CI：1.003~3.701，P=0.049)、颈部中央区淋巴结转移数>5个(调整后的比值比OR：2.630，95%CI：1.509~4.584，P=0.001)、颈侧区淋巴结转移数>5个(调整后的比值比OR：3.074，95%CI：1.649~5.730，P < 0.001)与肿瘤复发相关。结论 肿瘤大小、肿瘤多发、颈部中央区淋巴结转移数>5个、颈侧区淋巴结转移数>5个是DTC外科切除联合131I及TSH抑制治疗后复发的独立危险因素。Abstract: Objective To investigate the risk factors of recurrence after surgical resection of differentiated thyroid carcinoma combined with iodine-131 and TSH(Thyroid stimulating hormone) inhibition therapy.Methods From January 2015 to April 2020, the clinical data of patients with structural recurrence and without recurrence were retrospectively collected after surgical treatment combined with iodine-131 and TSH inhibition therapy in the First Medical Center of PLA General Hospital. The general conditions of the two groups of patients were analyzed and the measurement data in line with the normal distribution was used for comparison between groups. For measurement data with non-normal distribution, the rank sum test was used for inter-group comparison. The Chi-square test was used for comparison between the counting data groups. Univariate and multivariate regression analyses were used to determine the risk factors associated with relapse.Results The median follow-up period was 43 months(range 18-81 months) and 100 patients(10.5%) relapsed among the 955 patients. Univariate analysis showed that tumor size, tumor multiple, the number of lymph node metastases>5 in the central region of the neck, and the number of lymph node metastases>5 in the lateral region were significantly correlated with post-treatment recurrence(P < 0.001, P=0.018, P < 0.001, P < 0.001). Multivariate analysis showed that tumor size(adjusted odds ratio OR: 1.496, 95%CI: 1.226-1.826, P < 0.001), tumor frequency(adjusted odds ratio OR: 1.927, 95%CI: 1.003-3.701, P=0.049), the number of lymph node metastases in the central neck region>5(adjusted odds ratio OR: 2.630, 95%CI: 1.509-4.584, P=0.001) and the number of lymph node metastases in the lateral neck region>5(adjusted odds ratio OR: 3.074, 95%CI: 1.649-5.730, P=0.001) was associated with tumor recurrence.Conclusion The study showed that tumor size, tumor multiple, the number of lymph node metastases in the central region of the neck>5 and the number of lymph node metastases in the side of the neck >5 are independent risk factors for recurrence of differentiated thyroid cancer after surgical resection combined with iodine-131 and TSH inhibition therapy.
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Key words:
- thyroid neoplasms /
- iodine-131 therapy /
- surgical operation /
- thyroid stimulating hormone
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表 1 一般资料比较
例(%) 变量 复发组(n=100) 未复发组(n=855) t/χ2/Z P 年龄/岁 40.79±12.19 43.21±11.12 1.897 0.058 性别 0.185 女 62(62.00) 586(68.54) 1.754 男 38(38.00) 269(31.46) 住院天数/d 8.94±3.30 8.39±3.45 -1.504 0.133 治疗时间间隔/月 3.35±1.72 3.48±1.72 0.751 0.453 肿瘤大小/cm 1.86(1.14)1.50(1.00~2.50) 1.35(0.88)1.10(0.80~1.60) -4.356 < 0.001 单/多 5.670 0.017 单发 33(33.00) 389(45.50) 多发 67(67.00) 466(54.50) 肿瘤位置 2.506 0.286 峡部 0(0) 4(0.47) 单叶 50(50.00) 489(57.19) 双叶 50(50.00) 362(42.34) 包膜侵犯情况 1.869 0.393 侵透包膜 67(67.00) 599(70.06) 侵犯未侵透 6(6.00) 71(8.30) 未侵犯 27(27.00) 185(21.64) 危险分层 0.584 0.445 中风险 82(82.00) 673(78.71) 高风险 18(18.00) 182(21.29) 病理类型 3.550 0.470 乳头状癌 87(87.00) 720(84.21) 经典亚型 10(10.00) 74(8.65) 滤泡亚型 1(1.00) 41(4.80) 经典与滤泡 2(2.00) 17(1.99) 滤泡状癌 0(0) 3(0.35) 是否合并桥本 0.881 0.348 否 81(81.00) 657(76.84) 是 19(19.00) 198(23.16) 颈部中央区淋巴结阳性数 41.596 < 0.001 ≤5个 69(69.00) 776(90.76) >5个 31(31.00) 79(9.24) 颈部侧方区淋巴结阳性数 45.379 < 0.001 ≤5个 75(75.00) 805(94.15) >5个 25(25.00) 50(5.85) 
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表 2 单因素分析
暴露变量 OR(95%CI) P 性别 女 1.0 男 1.335(0.870，2.050) 0.186 年龄 0.981(0.963，0.999) 0.042 住院天数 1.041(0.987，1.098) 0.135 治疗时间间隔 0.953(0.840，1.081) 0.452 原发灶大小 1.582(1.319，1.897) < 0.001 单/多 单发 1.0 多发 1.695(1.094，2.626) 0.018 肿瘤位置 峡部 1.0 单叶 588733.428(0，Inf) 0.985 双叶 795278.029(0，Inf) 0.985 包膜侵犯情况 侵透包膜 1.0 侵犯未侵透 0.756(0.316，1.805) 0.528 未侵犯 1.305(0.810，2.101) 0.274 病理类型 乳头状癌 1.0 经典亚型 1.118(0.557，2.245) 0.753 滤泡亚型 0.202(0.027，1.486) 0.116 经典与滤泡 0.974(0.221，4.286) 0.972 滤泡状癌 0(0，Inf) 0.981 危险分层 中风险 1.0 高风险 0.812(0.475，1.387) 0.445 颈部中央区淋巴结阳性数 ≤5个 1.0 >5个 4.413(2.723，7.153) < 0.001 颈部侧方区淋巴结阳性数 ≤5个 1.0 >5个 5.367(3.142，9.166) < 0.001 是否合并桥本 否 1.0 是 0.778(0.461，1.315) 0.349
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表 3 多因素回归模型分析
暴露变量 OR(95%CI) P 原发灶大小 1.496(1.226，1.826) < 0.001 单/多 单发 1.0 多发 1.927(1.003，3.701) 0.049 颈部中央区淋巴结阳性数 ≤5个 1.0 >5个 2.630(1.509，4.584) 0.001 颈部侧方区淋巴结阳性数 ≤5个 1.0 >5个 3.074(1.649，5.730) < 0.001
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