甲状腺髓样癌患者手术治疗前、后血清降钙素比值对其预后评估的分析
Analysis of Serum Calcitonin Ratio before and after Operation in Patients with Medullary Thyroid Carcinoma on Its Prognosis Evaluation

目的：探讨甲状腺髓样癌患者手术治疗前、后血清降钙素比值对其预后评估的价值。方法：回顾性分析2017年10月~2020年6月因甲状腺结节就诊于青岛大学附属烟台毓璜顶医院甲状腺外科并行外科手术治疗的34例患者资料。所有患者手术前1天行血清降钙素检测，术后第3天复测。34例患者术后均有石蜡病理证实为甲状腺髓样癌。计算手术治疗前、后血清降钙素比值，分析其与患者性别、年龄、肿瘤大小、临床分期、有无包膜侵犯及淋巴结转移是否存在相关性，探讨其对甲状腺髓样癌患者预后的评估价值。结果：依据手术治疗前、后降钙素不同比值病所含病例数所占比例大小，选取比值50为界定值。通过Fisher确切概率法分析手术治疗前、后血清降钙素比值≥50与肿瘤大小及淋巴结转移存在明显相关性(P < 0.05)；而与患者性别、年龄，肿瘤有无包膜侵犯及临床分期无关(P > 0.05)。结论：手术治疗前、后降钙素比值≥50与肿瘤大小和淋巴结是否转移有关，提示血清降钙素比值可对手术治疗后甲状腺髓样癌患者预后进行初步评估，为预后较差的甲状腺髓样癌患者在手术治疗后进行早期干预或制定更为积极的随访提供了理论依据。
Objective: To evaluate the prognostic value of serum calcitonin ratio before and after surgical treatment in patients with medullary thyroid carcinoma. Methods: A retrospective analysis of the data of 34 patients who were treated with thyroid surgery, Yantai Yuhuangding Hospital of Medical College of Qingdao University due to thyroid nodules from October 2017 to June 2020. All patients were tested for serum calcitonin 1 day before surgery, and rechecked for serum calcitonin 3 days after surgery. 34 patients had clear paraffin pathology confirmed as medullary thyroid carcinoma after operation. Calculate the ratio of serum calcitonin before and after surgery, analyze its relationship with the patient’s gender, age, tumor diameter, capsule invasion, lymph node metastasis, and clinical stage of the tumor, and explore its prognostic value for patients with medullary thyroid cancer. Results: According to the proportion of different ratios of calcitonin in patients before and after surgical treatment, the ratio 50 was selected as the limit value. The Fisher’s exact probability method was used to analyze the serum calcitonin ratio ≥50 before and after surgery, which was significantly statistically significant with tumor size and lymph node metastasis (P < 0.05); it was not statistically significant with gender, age, capsule invasion and clinical stage (P > 0.05). Conclusion: The calcitonin ratio ≥50 before and after surgery is related to tumor size and lymph node metastasis, suggesting that the serum calcitonin ratio can be used for preliminary assessment of the prognosis of patients with medullary thyroid cancer after surgery, and it provides a theoretical basis for early intervention or more active follow-up after surgical treatment for patients with medullary thyroid carcinoma with poor prognosis.