The Value Of Serum MK And Gal-3 In The Diagnosis And Evaluation Of Therapeutic Effectiveness Of Thyroid Cancer

Objective:Firstly,to investigate values of serum midkine（MK）and galectine-3（Gal-3）as a diagnosticbiomarker in thyroid cancer（TC）before the surgery;secondly,to explorethe relationships between pre-¹³¹I-ablative MK and Gal-3with the effectiveness of the first¹³¹I remnant ablation and prognosis in differentiated thyroid cancer（DTC）patientsafter thyroidectomy;thirdly,to exploreother influential factors on the effectiveness of the first¹³¹I remnantablation therapy in them.Methods:1.A total of 42 patients（23 patients with TC and 19 patients with benign thyroid nodules）participated in the pre-surgical study.32 healthy subjects served as controls.Diagnostic values of pre-surgical MK and Gal-3 for TC were conducted by ROC（receiver operating characteristic）curves.2.A total of 51 DTC patients participated in the effectiveness of the first ¹³¹I remnant ablation study.All of them had accepted the second ¹³¹I treatment,collected serum before iodine treatment and recorded as serum MK（A）,Gal-3（A）and serum MK（B）,Gal-3（B）.According to ¹³¹I whole body follow-up scan after the second ¹³¹I therapy,they were divided into the complete-ablation group（29 cases）and uncomplete-ablation group（22 cases）.According to whether there was lymph node and/or lung metastasis,they were divided into metastasis positive group（8 cases）and negative group（43 cases）.Independent two-sample t test or Mann-Whitney U test were used to analyze the data.Pearson correlation analysis was used to analyze the relationship between MK and Gal-3(including pre-surgical and pre-¹³¹I-ablative)and other serum markers（including thyroglobulin（Tg）and thyroid stimulating hormone（TSH））.Theχ² test and multi-variance Binary logistic regression were performed for age,gender,lesions’maximum diameter,the time of operation from first¹³¹I treatment,lesions’number,TSH,Tg,residual thyroid weight,Tumor Node Metastasis（TNM）stage,American Thyroid Association（ATA）risk,urinary iodine,body mass index（BMI）.Results:1.Pre-surgical MK and Gal-3 levels were significantly higher in TC patients than those in benign thyroid nodule patients and those in controls（P<0.05）.The ROC curve analysis determined the optimal value of MK and Gal-3 for differential diagnosis between TC and benign thyroid nodules.The diagnostic power of MK was the highest at318.87pg/mL;at that value,the AUC（area under curve）was0.90±0.05;it had 78.3%specificity,88.2%sensibility.The diagnostic power of Gal-3 was the highest at 1.61ng/mL;at that value,the AUC was 0.71±0.09,it had 70.0%specificity,69.6%sensibility.MK and Gal-3 were significantly correlated in pre-surgical（P=0.04）.2.Pre-¹³¹I-ablative MK（A）levels was significantly higher in in-complete-ablation group than complete-ablation group（P=0.04）,but not in Gal-3（A）,MK（B）and Gal-3（B）levels（P=0.35）.MK（A）,Gal-3（A）and MK（B）,Gal-3（B）in metastasis positive group were significantly higher in negative group（P<0.05）.MK and Gal-3 were significantly correlated in pre-¹³¹I-ablative（P<0.05）,but pre-¹³¹I-ablative MK and Gal-3 were significantly correlated neither Tg or TSH（P>0.05）.3.The first ¹³¹I ablation therapy was successful in 29 of 51 patients（56.86%）.lesions’maximum diameter,TSH,residual thyroid weight and UIwere found to have affected the therapetutic efficacy,especially the group with lesions’maximumdiameter>1cm,levels of serumTSH for 60-90uIU/ml,less residual thyroid weight,mild iodine deficiency had better therapeutic effects than other group,the correspondingintra-groups statistical difference of the variance were significant byc² test（P<0.05）.Where the intra-group statistical differences of the remaining variances wereinsignificant（P>0.05）.Binary logistic regression analysis was performed in TSH and lesions’maximum diameter,residual thyroid weight,urinary iodine and it indicated that all were statistically significant independent variable（P>0.05）.Conclusion:1.Serum MKand Gal-3 colud be used to identify the benign and malignant thyroid nodules.And there was a certain correlation between serum MK and Gal-3,which mighthave a synergistic effect.2.The level of serum MK before the first ¹³¹I treatmentmight have a some correlations with the effectiveness of the first ¹³¹I ablation therapyin DTC patientsafter thyroidectomy;serum MKand Gal-3 might have some clinical value for the prognosis of them.3.The factor including TSH and lesions’maximum diameter,residual thyroid weight,urinary iodine could influence effects of the first ¹³¹I remnant ablation therapy in DTC patients after thyroidectomy.