摘要
目的探讨甲状腺髓样癌肿瘤复发的危险因素。方法回顾性分析2010年1月至2018年1月天津医科大学肿瘤医院初诊的172例甲状腺髓样癌患者的临床资料,根据随访结果分为肿瘤复发组和无肿瘤复发组,对比两组病例的超声特征、RET基因型及临床病理学特征,通过受试者工作特征曲线分析计算出连续变量术前及术后血清降钙素的截点值,单因素、多因素回归及Kaplan-Meier生存曲线分析确定甲状腺髓样癌肿瘤复发的独立危险因素。结果单因素分析显示,术前血清降钙素≥1367 pg/ml(χ^(2)=18.909,P=0.000)、术后血清降钙素≥61 pg/ml(χ^(2)=72.278,P=0.000)、多灶性(χ^(2)=11.787,P=0.001)、双侧腺叶发病(χ^(2)=10.452,P=0.003)、原发灶甲状腺外侵犯(χ^(2)=14.511,P=0.000)、T3+T4期(χ^(2)=11.920,P=0.001)、TNMⅢ+Ⅳ期(χ^(2)=18.915,P=0.000)、美国放射学会甲状腺影像报告与数据系统5类(χ^(2)=7.162,P=0.006)及RET原癌基因突变(χ^(2)=10.937,P=0.001)均与肿瘤复发有关。多因素回归分析显示,术后血清降钙素≥61 pg/ml(OR=22.323,95%CI:6.370~78.236)和RET原癌基因突变(OR=4.054,95%CI:1.354~12.139)是肿瘤复发的独立危险因素。生存曲线分析证实了术后血清降钙素(P=0.000)和RET基因型(P=0.001)是影响患者无瘤生存的因素。结论术后血清降钙素≥61 pg/ml和RET原癌基因突变是甲状腺髓样癌肿瘤患者复发的独立危险因素。
Objective This study aimed to investigate the risk features of postoperative tumor recurrence of medullary thyroid carcinoma.Methods One hundred and seventy two patients with medullary thyroid carcinoma diagnosed at Tianjin Cancer Hospital between Jan 2010 and Jan 2018 were enrolled in this study.Based on the follow-up results,patients were divided into tumor recurrence and non-tumor recurrence group.US features,clinicopathological characteristics and somatic RET mutations were evaluated between the two groups.The cut-off values of pre-and post-operative serum calcitonin were calculated by ROC curve.Univariate and multivariate analysis were adopted between the two groups to determine independent risk factors for tumor recurrence of MTC.Tumor-free survival was determined by Kaplan-Meier analysis.Results Univariate analysis showed that preoperative serum calcitonin≥1367 pg/ml(χ2=18.909,P=0.000),postoperative serum calcitonin≥61 pg/ml(χ2=72.278,P=0.000),mulifocality(χ2=11.787,P=0.001),lesions in both lobes(χ2=10.452,P=0.003),extrathyroidal invasion(χ2=14.511,P=0.000),T3+T4-staging(χ2=11.920,P=0.001)、TNMⅢ+Ⅳ-staging(χ2=18.915,P=0.000),ACR TI-RADS 5(χ2=7.162,P=0.006)and RET mutation(χ2=10.937,P=0.001)were significantly related to tumor recurrence of medullary thyroid carcinoma.Multivariate analysis demonstrated that postoperative serum calcitonin≥61 pg/ml(OR=22.323,95%CI:6.370-78.236)and RET mutation(OR=4.054,95%CI:1.354-12.139)were the independent factors related to tumor recurrence of medullary thyroid carcinoma.The survival curves of MTC patients showed a significantly lower percentage of surviving patients in the group with postoperative serum calcitonin≥61 pg/ml(P=0.000)or RET mutations(P=0.001).Conclusions Postoperative serum calcitonin≥61 pg/ml and oncogenic RET mutation were the independent risk factors for tumor recurrence of MTC.Patients with postoperative serum calcitonin≥61 pg/ml or a RET mutation tended to have a shorter tumor-free survival.
作者
赵静
张蕾
侯文静
赵利辉
毛怡然
穆洁
朱佳琳
郑向前
魏玺
Zhao Jing;Zhang Lei;Hou Wenjing;Zhao Lihui;Mao Yiran;Mu Jie;Zhu Jialin;Zheng Xiangqian;Wei Xi(Department of Diagnostic and Therapeutic Ultrasonography,Tianjin Medical University Cancer Hospital,Tianjin 300060 China;Department of Thyroid and Neck Tumor,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin Clinical Research Center for Cancer,Tianjin 300060 China)
出处
《中华普通外科杂志》
CSCD
北大核心
2023年第10期738-743,共6页
Chinese Journal of General Surgery
关键词
甲状腺肿瘤
肿瘤复发
局部
降钙素
超声检查
Thyroid neoplasms
Tumor recurrence,local
Calcitonin
Ultrasonography
