| BackgroundThe thyroid cancer has the highest incidence of endocrine organ tumor in human, whereas medullary thyroid carcinoma and thyroid carcinoma are very rare. Once the Cancer is diagnosed and clinically proved, the survival period of the patients is usually within six months. There is no effective treatment currently. Differentiated thyroid cancer (DTC) accounts for the vast majority of the disease pathological types of thyroid cancer. According to the domestic clinical data in 2011, it takes up around 95% in percentage. This kind of differentiated thyroid cancer is divided into follicular thyroid carcinoma, papillary thyroid carcinoma and hybrid, and most of the patients have experienced effective treatments of surgical resection followed by the comprehensive treatment of 131Ⅰ treatment and hormone replacement therapy.At present, the diagnosis of thyroid cancer surgery of the most commonly used detection method is thyrobolulin detection and 131Ⅰ whole body scan, but these methods have some extent of false positives and false negatives. Therefore, to find some differentiated thyroid cancer postoperative 131Ⅰ treatment monitoring indicators, will be beneficial to the postoperative monitoring and transfer assessment for the patients of such type of cancer.The research in recent years has shown that the tumor metastasis is associated with angiogenesis, and the formation of blood vessels is primarily the result of vascular endothelial growth factor (VEGF) and endothelial inhibition (ES) synergy, the change of the two factors is involved in the tumor recurrence or metastasis. The medical circles both domestic and abroad have studies on the VEGF in breast cancer, liver cancer, colorectal cancer, the change of differentiated thyroid cancer before and after surgery and the assessment value of the postoperative transfer, but very few reports on the 131I treatment postoperatively in patients with differentiated thyroid cancer in both level change was seen. Therefore, to study changes in the level of the serum vascular endothelial growth factor and endothelial in the patients with differentiated thyroid cancer postoperative metastasis and 131I treatment.ObjectiveTo explore the VEGF and ES levels in the serum of patients with thyroid cancer postoperative metastasis, the relationship between serum VEGF, serum ES and the serum thyroglobulin concentration.MethodsFrom June 2006 to December 2010, there were 77 thyroid cancer Postoper ative Patients were treated by 131I in Nuclear Medicine Department LiaoChengP eople’s Hospital. They were divided into three groups according to whether has metastasis and the metastasis site. There are 33 caes in no metastasis group,2 5 cases local lymph node metastasis group and 19 caes in lung metastasis gro up, we also set 33 cases whose thyroid tissue structure and function are norma 1 as a control group. All patients’pathological type were confirmed by postope rative pathology. Patients with local lymph node metastasis were confirmed by fine needle aspiration cytology, Patients with lung metastasis were confirmed b y chest CT and 131I scan results and the control group were confirmed through thyroid ultrasonic and thyroid function test. Give the patients with different tim es of 131I treatments according to the patients conditions. The treatment interval for removing the remaining thyroid tissue is 6 months, and the treatment interv al for removing the metastasis lesions is 3 months. To all patients, each timeb efore/after stop taking thyroid hormone, Detection the expression level of VE GF and ES with enzyme-linked immunosorbent assay (ELISA), and detection t he concentration of serum FT3, FT4, TSH, Tg, TgAb with chemiluminescence.I ndividually compare the expression level of VEGF and ES before each 131I tre atment and 2 months after each 131I treatment. Implement comparison among p ulmonary metastasis group, neck local lymph node metastasis group, no metasta sis group and control group before the first 131I treatment and implement intern al group comparison before or after stop taking the thyroid preparations to obs erve if the concentration of VEGF and ES has significance difference and their correlation with thyroglobulin concentration. Use SPSS 19.0 statistics software pa ckage to analysis. Adopt Spearman rank correlation analysis to analyze the corr elation of VEGF, ES and serum thyroglobulin concentration.Results(1)The VEGF and ES (589.5±140.2pg/ml,37.5±8.92ng/ml) of lung metasta sis group were significantly higher than that of the local lymph node metastasi s group(365.5±52.1pg/ml,31.5±6.54ng/ml), no metastasis group(210.7±47.3pg/ml,2 6.0±4.04ng/ml) and the control group (189.4±35.5pg/ml,28.0±5.3ng/ml). The VE GF and ES of local lymph node metastasis group was significently higher than that of no metastasis group and control group, and the difference comparisons all have statistical significance(P<0.05).The difference comparison of no metasta sis group and control group has no satistical significance (P>0.05).The ratio of VEGF and ES of lung metastasis group, local lymph node metastasis group, co ntrol group and no metastasis group werel4.9、11.4、7.94、6.52.respectively. C omparing with that before stop taking thyroid preparations, VEGF was significa ntly higher and the difference has statistically significant (P<0.05); ES concentr ation increased than before stop thyroid preparations, but the differrence compari son has no statistically significant(P>0.05).4weeks after stop taking thyroid prep arations the VEGF and ES (1401.3±289.4pg/ml,42.8±9.9ng/ml) of lung metasta sis group was significantly higher than that of the local lymph node metastasis group(800.1±220.4pg/ml,36.0±9.48ng/ml), no metastasis group (320.4±75.56pg ml,28.1±6.79ng/ml) and control group. The VEGF and ES of local lymph node metastasis group was significantly higher than that of node metastasis group; and control group; and the differences comparisons all have statistically signifi cant(P<0.05). The difference comparison of node metastasis group and the cont rol group has no significant differentce(P>0.05).The ratio of VEGF and ES of lung metastasis group, local lymph node metastasis group, and no metastasis gr oup were 33.9,21.2,11.5 respectively. (2)Before stop taking thyroxine, for pati ents with local lymph node metastasis of thyroid cancer, the average serum thy roglobulin concentration was 35.29±14.01ug/L, the VEGF was 365.5±52.1pg/ml and the ES was 31.5±6.54ng/ml, for patients with lung metastasis, the average serum thyroglobulin concen trations was 77.49±22.78ug/L, the VEGF was 589. 5±140.2pg/ml and the ES was 37.5±8.92ng/ml.Correlation analysis showed that the serum thyroglobulin concentration and the VEGF and the ES expression of patients with thyroid cancer metastasis are in linear positive correlation. (r=0.7 678,0.326,P<0.01). After stop taking thyroxine, for patients with local lymph n ode metastasis, the serum thyroglobulin concentration was 97.59±28.40ug/L,the VEGF was 800.1±220.4pg/ml and the ES was 36.0±9.48ng/ml,for Patients with lung metastasis, the average serum thyroglobulin concentrations was 391.6±19. 93ug/L, the VEGF was 1401.3±289.4pg/ml and the ES is 42.8±9.9ng/ml.Correla tion an alysis showed that the serum thyroglobulin concentrationand the VEGF and the ES expression of patients with thyroid cancer metastasis are in linear positive correlation. (r=0.826,0.354, P<0.01). The studying results ofthe serum VEGF, ES of patients after 131I treatment.(1)Under the condition of not stop ta king thyroid Preparations, compare the data before 131I treatment and the data 2months after the first time treatment. The results showed that:For lung metast asis and local lymph node metastasis groups the VEGF and ES level was lowe r,but had no significant change and VEGF/ES ratio was lower than before 131I treatment.The VEGF, ES and VEGF/ES ratio of no metastasis group have no s ignificant change compared with that before 131I treatment. (2) Under the condi tion of not stop taking thyroid preparations during the second and third 131I tre atment,For lung metastasis and local lymph node metastasis groups, the VEGF was significantly reduced, ES had no significant changes, VEGF/ES ratio was 1 ower than that before each 131I treatment.Conclusions(1) The Serum VEGF levels of patients with postoperative metastasis of th yroid cancer is significantly increased, and showed a good correlation with thyr oglobulin, which can be used as an important indicator in the detection of thyr oid cancer. (2) 131I treatment can lower the VEGF/ES ratio and reduce the for mationof tumor vessel. |
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