| Objecive: To investigate the clinical outcomes after 131 I “Remove residual thyroid gland.” treatment in patients with DTC(preablative stimulation of thyroglobulin,ps-Tg)<10ng/ml before 131 I treatment,And assess the predictive value of Ps-Tg for clinical outcomes.Analysis of whether the thyroglobulin level is negative is still a risk factor affecting the efficacy of removing residual thyroid tissueMethods:1.Retrospectively collected patients with cervical lymph node metastases diagnosed with DTC in our hospital from 2014 to 2017.All thyroidectomy and cervical lymph node dissection were performed.2.After the surgery,patients without contraindications to 131 I treatment discontinued or stopped taking L-T4,and iodine-free diet for 2-4 weeks resulted in 131 I clearance of TSH > 30 ?IU/ml.Comprehensive evaluation of postoperative pathology and pre-treatment examination determined the 131 I treatment dose,and adjuvant drugs were given after treatment.After 7 days131 I therapeutic total body imaging(RX-WBS)was performed.After about six months,L-T4 was stopped.When TSH was >30 mU/L,Tg levels were reviewed and 131 I diagnostic whole body imaging(DX-WBS)was performed.Pathological biopsy was confirmed when recurrence and metastasis were suspected.According to the 2015 ATA guidelines,the thyroid cancer "removal residual thyroid gland" after treatment response evaluation system wasdivided into ER group(n = 42),AR group(n = 11)and IR group(n = 22),compared between the 3 groups.3.According to Clinical features and Ps-Tg levels,Further divided into ER group and non-ER group,the application of ROC curve and determine the best diagnostic cut-points to evaluate the predictive value of the two groups of Ps-Tg levels on ER and recurrence and distant metastasis.5.Mann-Whitney H test was used to compare differences in TgAb levels between the ER,AR and IR groups,and 75 TgAb values were divided into two groups.G1 group: TgAb <60 U/ml,G2 group: 60 U/ml ? TgAb <115U/ml.A four-table chi-square test was used to compare the efficacy of the two groups in removing residual thyroid tissue.Results:1."Elimination of Residual Thyroid Efficacy" : Of the 75 patients,42 cases had their residual thyroid clearance achieved ER criteria for the first time,with a success rate of 56%(42/75).Eleven patients achieved the AR standard of 14.7%(11/75)after the first treatment.and another 29.3%(22/75)patients failed for the first time to "clear the residual thyroid gland."2.In general,the gender of the three groups(x2=0.609,p=0.737),age(F=0.360,p=0.699),TNM stage(x2=2.355,p=0.886),and stratification risk stratification(x2=2.974,p=0.562)The difference was not statistically significant,and the difference in Ps-Tg levels was statistically significant(H=9.857,p=0.003).According to whether the patients were completely cleared after the first time the residual thyroid gland was cleared,the patients were further divided into ER group and non-ER group.The results showed that the difference of Ps-Tg between the two groups was statistically significant(U=481,P=0.024).3.The median Ps-Tg level in the ER group was 1.81 ng/ml,which was significantly lower than that in the non-ER group 3.31 ng/ml.The difference in Ps-Tg levels between the two groups was statistically significant(U=481,p=0.024).4.The area under the ROC curve of the relationship between Ps-Tg level and disease-free survival was 0.717;the cut-off point of ps-Tg was 3.23 ng/ml,corresponding sensitivity,specificity,positive predictive value and negative predictive value were 61.76% respectively.(21/34)and 92.68%(38/41),87.50%(21/24)and 74.51%(38/51)5.There was no significant difference in TgAb levels between ER,AR,and IR groups(U=605,P=0.348).The success rate of clearance of residual thyroid tissue in G1 group(70.7%)was higher than that in G2 group(44.1 %).There was statistical significance(?2=5.429,p=0.033).Conclusions:1.The first 131 I clearance of residual thyroid tissue in patients with thyroid papillary carcinoma showed significant differences in the levels of Ps-Tg between the cured and non-cure groups,suggesting that even lower levels of Ps-Tg are associated with 131 I clearance of residual thyroid tissue.2.When the ps-Tg cutoff point is 3.23 ng/ml,most patients can get better disease outcomes,suggesting that this value can be used as a reference value in clinical work,which is beneficial to the patient's comprehensive treatment plan and reduce over treatment.3.When the TgAb was negative and the Ps-Tg value was <3.23 ng/ml.There was still a small number of patients who need “removal of residual thyroid” after treatment.The clinical work should be combined with Ultrasound of the neck,WBS imaging methods and tumor pathologicalcharacteristics to assess the patient's disease status and prognosis,in order to obtain the best treatment program.4.The difference between the two statistical results of TgAb levels suggests that the effect of negative TgAb levels on the elimination of residual thyroid tissue is not ruled out,and subsequent large-sample,multi-center studies are still required. |
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