中国实用外科杂志

中国实用外科杂志

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甲状腺髓样癌病人围手术期降钙素及癌胚抗原水平变化研究

张大奇，张    晗，隋成秋，梁    楠，孙    辉   

  1. 吉林大学中日联谊医院甲状腺外科  吉林省外科转化医学重点实验室吉林省甲状腺疾病防治工程实验室，吉林长春130033
  • 出版日期:2020-09-01 发布日期:2020-09-21

  • Online:2020-09-01 Published:2020-09-21

摘要： 目的    研究术前血清降钙素（Ctn）及癌胚抗原（CEA）水平与甲状腺髓样癌（MTC）病人临床病理特征的相关性，探讨术后血清Ctn及CEA水平的变化以及其对MTC预后的预测价值。方法    收集2008年6月至2020年6月于吉林大学中日联谊医院甲状腺外科手术治疗的92例甲状腺髓样癌病人的血清Ctn、CEA水平及临床病理特征信息和随访资料，回顾性分析围手术期及术后血清Ctn和CEA水平的变化及其与疾病进展的相关性。结果    术前血清Ctn水平与临床病理特征的单因素分析结果显示，多癌灶、N分期较高、肿瘤直径较大病人的术前Ctn水平更高（P＜0.01）。多因素分析结果显示，肿瘤大小、N分期与术前Ctn水平呈正相关。应用ROC曲线分析预测N1b转移的最佳血清Ctn水平切点值为167 ng/L，曲线下面积为0.842，灵敏度85.3%，特异度77.6%。术前血清CEA的分析结果显示，肿瘤直径≥4 cm时，术前CEA水平值更高。根据血清Ctn变化情况，将术后随访病人分为缓解组、稳定组和进展组。绘制3组病人的无病生存情况（DFS）的K-M曲线，结果显示不同Ctn水平变化情况与DFS显著相关，进展组病人的DFS较差。Ctn水平进展组病人的原发灶肿瘤直径更大（P=0.012）或N分期更高（P＜0.01）。大部分进展组病人在术后12~36个月出现明显的血清Ctn水平倍增，但CEA水平并无明显变化。结论    术前血清Ctn水平对MTC病人的瘤负荷和淋巴结转移具有较好的预测能力，术后血清Ctn水平变化可较好地反映MTC病人的病情进展情况，而围手术期CEA水平的变化没有Ctn水平敏感。

关键词: 甲状腺髓样癌, 降钙素, 癌胚抗原, 随访

Abstract: Study on changes of calcitonin and carcinoembryonic antigen in perioperative period of medullary thyroid carcinoma： An analysis of 92 cases        ZHANG Da-qi, ZHANG Han, SUI Cheng-qiu,et al. Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University; Jilin Provincial Key Laboratory of Surgical Translational Medicine; Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control, Changchun 130033, China
Corresponding author: SUN Hui ,E-mail：s_h@jlu.edu.cn
Abstract    Objective    To study the correlation between preoperative serum calcitonin（Ctn）and carcinoembryonic antigen（CEA）with clinicopathological characteristics of patients with medullary thyroid carcinoma（MTC）, and to explore the postoperative changes of serum Ctn and CEA and their roles on predicting MTC prognosis. Methods    The serum Ctn, CEA, clinicopathological information and follow-up data of 92 MTC patients treated by thyroid surgery in China- Japan Union Hospital of Jilin University from June 2008 to June 2020 were collected. The changes of serum Ctn and CEA during perioperative and postoperative period were analyzed retrospectively. The correlation between the changes and disease progression were also evaluated. Results    The univariate analysis of preoperative serum Ctn and clinical characteristics showed that the preoperative Ctn was higher in patients with multifocality, higher N stage, and larger tumor diameter（P＜0.01）. Multivariate analysis showed that tumor size and N stage were positively correlated with the level of preoperative Ctn. The best serum Ctn cut off value for predicting N1b metastasis was 167 ng/L (the area under the curve was 0.842, the sensitivity was 85.3%, and the specificity was 77.6%). The preoperative CEA level was higher when the tumor diameter was ≥4 cm. According to the changes of serum Ctn, the postoperative follow-up patients were divided into remission group, stable group, and progression group. The K-M curves of disease-free survival（DFS）showed that the progressive patients had poor DFS. In addition, patients in the Ctn progression group had a larger primary tumor diameter（P=0.012）or a higher N stage（P＜0.01）. Most progressive patients showed obvious increase in serum Ctn from 12 months to 36 months after surgery, but no significant change in CEA. Conclusion    Preoperative serum Ctn has a good predictive ability for tumor burden and lymph node metastasis for MTC patients. Postoperative changes of serum Ctn could better reflect the progress of MTC, while CEA changes are not as sensitive as Ctn.

Key words: medullary thyroid carcinoma, calcitonin, carcinoembryonic antigen, follow-up