Explore Monitoring Index And Influencing Factors Of The Postoperative Recurrence And Metastasis Of Differentiated Thyroid Cancer

Objective: The ultrasound image data and thyroid functional data of thepostoperative follow-up of thyroid cancer cases are retrospectively analyzed,to explore the relationship between postoperative recurrence and metastasis ofdifferentiated thyroid carcinoma and these factors that are ultrasound, lymphnode metastasis of primary surgery, follow-up time，the risk stratification ofrecurrence and Thyroglobulin (Tg), to improve early diagnosis ofpostoperative recurrence and metastasis of differentiated thyroid carcinomaand guide postoperative treatment and program of follow-up.Methods:144patients of differentiated thyroid carcinoma withconfirmed pathological types and long-term follow-up are divided into twogroups. There are47cases in postoperative group of recurrence and metastasis.They are patients of thyroid carcinoma or lymph node with confirmedpathological types of the second surgery. There are97cases in postoperativegroup without recurrence or metastasis. Their ultrasonic images suggest thatthyroid area is postoperative change and have no abnormal change by closefollow-up. Postoperative follow-up ultrasound image data and thyroidfunction data of all patients were analyzed retrospectively (All the results arereported by our hospital). Compare the differences of the postoperativedifferentiated thyroid carcinoma with recurrence and metastasis or not inultrasound, follow-up time, the risk stratification of recurrence, lymph nodemetastasis of primary surgery and Thyroglobulin (Tg). According to the riskstratification of recurrence of postoperative thyroid carcinoma, we dividepatients of differentiated thyroid carcinoma into different groups:①low-riskgroup, cases of meeting all the following requirements: no local or distantmetastasis; all visible tumors of complete clear; no violation of the surrounding tissue; not invade histologic subtype of the type without vascularinvasion; no abnormal iodine intake in thyroid bed if the patient doposttreatment whole scan after cleaning the thyroid.②risk group, cases ofmeeting any following requirement: no violation of the surrounding tissue ofprimary surgical pathology；lymph node metastasis or abnormal iodine intakeby posttreatment whole scan after cleaning the thyroid invade histologicsubtype of the type; vascular invasion;③high-risk group, cases of meetingany following requirement: visible violation of the surrounding tissue andorgan of tumors; tumors of incomplete clear or a small amount of residue；distant metastasis；high Tg level in serum after total thyroidectomy; a familyhistory of thyroid cancer. All data were analyzed by SPSS19.0statisticalsoftware. All aspects of the statistics of postoperative differentiated thyroidcarcinoma were compared by using the chi-square test. P<0.05, there isstatistical significance.Results: In144postoperative patients of differentiated thyroid carcinoma,140cases are postoperative thyroid papillary carcinoma (97.2%), and4casesare follicular thyroid carcinoma postoperatively (2.8%). There are47cases ofrecurrence or metastasis (32.6%), and97patients who have223times ofregular follow-up with non-recurrence or metastasis (67.4%).The thyroid echoes in270cases of postoperative follow-up of thyroidcarcinoma are uneven echo. In following up patients of postoperativerecurrence with thyroid carcinoma,37cases are ultrasonic low echo (94.9%)and2cases are other echo (5.10%). In the postoperative follow-up withoutrecurrence of thyroid cancer cases,178cases are ultrasonic low echo (79.8%),and45cases are other echo (20.2%).45cases of other echo include21casesof slightly higher echo,10cases of mixed echo,9cases of high echo,5casesof such as echo. P=0.023, there is statistical significance.In the postoperative follow-up of cases with thyroid carcinomarecurrence，33cases are dot strong echo (84.6%), and6cases are other strongecho (15.4%). In the postoperative follow-up without recurrence of thyroidcancer cases, there are dot strong echo of65cases (29.2%), short line strong echo of54cases (24.2%) and other strong echo of104cases (46.6%). P=0.000, so there is statistical significance.In the postoperative follow-up of cases with thyroid carcinomarecurrence,there are33cases of lymph node metastasis,including26cases ofthe first surgery with lymph node metastasis (78.8%) and7cases of firstsurgery without lymph node metastasis (21.2%). In the postoperativefollow-up with recurrence of thyroid cancer cases, there are16cases withoutlymph node metastasis,including5cases of the first surgery with lymph nodemetastasis (35.7%) and9cases of first surgery without lymph node metastasis(64.3%). P=0.007, so there is statistical significance.According to the record number of follow-up time, there are47cases ofthe postoperative thyroid carcinoma with recurrence and metastasis:6cases in1year (12.8%),17cases from1year to2years (36.2%),13cases from2to3years (27.7%),,11cases from3to4years(23.4%); and there are223cases ofpostoperative thyroid cancer without recurrence or metastasis:78cases in1year (35.0%),60cases from1year to2years (26.9%),49cases from2to3years,(22.0%),36cases from3to4years (16.1%). P=0.028, there isstatistical significance.According to the risk stratification of thyroid cancer recurrence, thepatients of postoperative thyroid carcinoma are divided into low-risk groupand group of moderate and high risk. In88cases of low-risk group, there are7cases of recurrence and metastasis (14.9%) and81cases without recurrenceor metastasis (83.5%). In56cases of group of moderate and high risk, thereare40cases of recurrence and metastasis (85.1%) and16cases withoutrecurrence or metastasis (16.5%). P=0.000, there is statistical significance.In the condition of TSH suppression after total thyroidectomy,69cases ofTg value are measured. With Tg value of disease-free survival tangent point of1ng/ml for the standard,>1ng/ml of Tg is defined as rise,1ng/ml or less ofTg is considered no rise. In13cases of postoperative thyroid carcinoma withrecurrence and metastasis,10cases of Tg value rise (76.9%), and3cases ofTg value do not rise (23.1%). In56cases of postoperative thyroid carcinoma without recurrence or metastasis,8cases of Tg value rise (14.3%), and48cases of Tg value do not rise (85.7%). P=0.000, there is statisticalsignificance.Conclusion: Ultrasonic low echo, ultrasonic dot strong echo, follow-uptime and Thyroglobulin (Tg) are statistically significant on monitoringpostoperative recurrence and metastasis of differentiated thyroid carcinoma.Lymph node metastasis of primary surgery and the risk stratification ofrecurrence are influencing factors of postoperative recurrence and metastasisof differentiated thyroid carcinoma, which have prognostic meaning.