ABSTRACT
Objective:To explore the predictive value of preablative stimulated thyroglobulin (psTg) level before 131I treatment on the excellent response (ER) to 131I treatment in patients with functional residual lymph node metastasis without distant metastasis after papillary thyroid carcinoma (PTC) surgery. Methods:From March 2011 to June 2015, 72 patients (22 males, 50 females, age: 14-76 (46.5±14.4) years) who were diagnosed with functional lymph node metastasis without distant metastasis at the time of their first 131I treatment after total thyroid bilobectomy + lymph node dissection performed in the Affiliated Cancer Hospital of Zhengzhou University were retrospectively included, and their serum thyroglobulin antibody (TgAb) levels were normal. Patients were divided into ER group and non-ER group according to the treatment response assessment system. Independent sample t test, χ2 test, and Mann-Whitney U test were used to compare the basic clinical characteristics between the two groups, and then multivariate logistic regression was performed. The ROC curve was employed to evaluate the predictive value of psTg and lymph node size in 131I treatment response. Results:The treatment responses of 44 patients were ER, and those of 28 were non-ER. The differences in gender, age, clinical stage, number and location of postoperative metastatic lymph nodes between ER and non-ER groups were not statistically significant ( t=0.82, χ2 values: 0.16-2.60, all P>0.05), while there were significant differences in American Thyroid Association (ATA) initial risk stratification ( χ2=33.38), lymph node size ( U=296.50) and psTg ( U=111.00, all P<0.001). PsTg (odds ratio ( OR)=0.047, 95% CI: 0.004-0.500, P=0.011) and lymph node size ( OR=0.146, 95% CI: 0.032-0.666, P=0.013) were independent factors affecting ER, whereas ATA initial risk stratification was not an independent factor ( OR=0.266, 95% CI: 0.051-1.390, P=0.116). AUCs for psTg and lymph node size were 0.904 and 0.873, respectively. The cut-off value of psTg was 20.05 μg/L with the sensitivity and specificity of 96.4%(27/28) and 75.0%(33/44) respectively, and lymph node size was 0.75 cm with the sensitivity and specificity of 78.6% (22/28) and 81.8% (36/44) respectively. Conclusion:PsTg can be used to predict 131I outcomes in patients with functional lymph node metastases after PTC, and lymph node size also has effect on ER.
ABSTRACT
Objective:To analyze the association between thyroglobulin antibody (TgAb) and differentiated thyroid cancer (DTC) metastases detected by post-radioactive iodine (RAI) therapy scan, when stimulated thyroglobulin (sTg) <1 μg/L.Methods:A total of 314 (68 males, 246 females, age (44.5±12.5) years) post-thyroidectomy DTC patients whose sTg <1 μg/L between March 2013 and May 2017 in Henan Cancer Hospital were enrolled retrospectively. Patients underwent 131I whole-body planar imaging ( 131I-WBS) and SPECT/CT imaging 5 d after 131I administration. Iodine avid metastases were compared between TgAb-positive group and TgAb-negative (TgAb<4 kU/L) group. Logistic regression analysis was conducted to assess odds ratio ( OR) for iodine avid metastases in each subgroup (Q1: 4 kU/L≤TgAb≤9.27 kU/L; Q2: 9.27 kU/L<TgAb≤26.75 kU/L; Q3: 26.75 kU/L<TgAb≤101.43 kU/L; Q4: TgAb>101.43 kU/L) of TgAb-positive patients, with the TgAb-negative patients as the reference. χ2 test was used to analyze the data. Results:Iodine avid metastases were found in 16.9% (53/314) of DTC patients and were more frequently in TgAb-positive group with TgAb>26.75 kU/L than TgAb-negative group (26.0%(19/73) vs 13.7%(23/168); χ2=5.382, P=0.02). Most metastases (92.5%, 49/53) occurred in cervical and mediastinal lymph nodes. The OR for iodine avid metastases was obviously high in TgAb-positive patients with 26.75 kU/L<TgAb≤101.43 kU/L ( OR(95% CI): 3.687(1.397-9.733), P=0.008) and with intermediate-high risk of recurrence ( OR(95% CI): 2.489(1.169-5.301), P=0.018), with the TgAb-negative group as the reference. Conclusion:The possibility of functional metastasis should be fully considered during 131I therapy in TgAb-positive DTC patients after surgery who have higher TgAb level and risk stratification, even if sTg<1 μg/L.
ABSTRACT
Objective:To evaluate the clinical value of 125I seed implantation guided by CT in treatment of advanced pancreatic cancer. Methods:The data of 63 patients with advanced pancreatic cancer in the Affiliated Cancer Hospital of Zhengzhou University from Jun. 2015 to Jun. 2018 (48 males and 15 females) were retrospectively analyzed. All patients underwent CT-guided 125I seed implantation, and regular follow-up after operation. All patients were followed up for 3 to 36 months to evaluate the clinical efficacy, including the volume of cancer before and after treatment, tumor marker CA199 and changes in complications such as abdominal pain and jaundice, and the survival status of the patients. Results:Three months after seed implantation, 9 cases (14.3%) had complete remission of cancer in 63 patients, 33 cases had partial remission (52.4%) , 15 cases had no change (23.8%) , and 6 cases had disease progression (9.5%) . The total effective rate was 67.7%. Three months after treatment, the volume of cancer was (31.92±14.93) cm 3, which was significantly smaller than that before treatment [ (44.88±16.19) cm 3; t=6.79, P<0.01]. Three months after treatment, Serum CA199 (77.21±58.69 U/ml) was significantly lower than that before treatment (327.76±110.42) U/ml ( t=16.56, P<0.05) . 125I seed implantation for advanced pancreatic cancer had an average survival period of (13.04±0.92) months and a median delivery period of 11 months. Of the 57 patients with different degrees of abdominal pain, 49 were better than before, and the pain relief rate was 85.9%. Among 42 patients with jaundice symptoms of varying degrees, 31 were better than before, and the jaundice remission rate was 73.8%. There were no serious complications related to treatment in any patients. Conclusion:125I seed implantation therapy can safely and effectively treat advanced pancreatic cancer, and improve related clinical symptoms such as abdominal pain and jaundice.
ABSTRACT
Objective@#To investigate the clinical value of pre-ablation stimulated thyroglobulin (psTg) in the prediction of metastasis of differentiated thyroid carcinoma (DTC) in children and adolescents.@*Methods@#The study included 51 children and adolescent patients (20 males, 31 females, age: 8-18(13.5±3.0) years) with DTC who had undergone total thyroidectomy and lymphadenectomy and were going to have the first 131I ablation therapy from March 2012 to December 2017 in the Affiliated Cancer Hospital of Zhengzhou University. Patients′ serum thyroglobulin antibody (TgAb) levels were normal. They were divided into M0 group (without metastasis) and M1 group (with metastasis). The psTg difference between the two groups was compared using Mann-Whitney U test. The receiver operating characteristic (ROC) curves and diagnostic critical point (DCP) of psTg for the metastasis prediction were analyzed.@*Results@#The psTg levels of M0 group (n=20) and M1 group (n=31) were 5.76(3.38, 18.51) μg/L and 280.46(37.66, 470.00) μg/L, respectively, and the difference between the two groups was statistically significant (U=41, P<0.05). The area under the ROC curve of psTg was 0.934 (95% CI: 0.869-0.999) with the sensitivity, specificity and accuracy of 80.6%(25/31), 100%(20/20) and 88.2%(45/51) respectively, with the DCP value of 31.98 μg/L.@*Conclusion@#The psTg value detected before the first 131I treatment has an important predictive value for postoperative metastasis of DTC in children and adolescents.