| Preliminary Application of IL-6 in Clinical Diagnosis andTreatment Strategy of Differentiated Thyroid CancerAt present,no serological markers have been found that can effectively distinguish thyroid benign and malignant diseases.Tg is an important indicator to monitor tumor recurrence and metastasis in DTC patients underwent total thyroidectomy.But Tg value is interfered with TgAb.When TgAb is positive,Tg values can not represent the real Tg level in the body,which will interfere with the clinician’s judgment of the patient’s condition.A lot of studies have shown that interleukin-6（IL-6）is significantly correlated with the occurrence,invasion,metastasis,and prognosis of DTC.This study,consisted of two parts,intends to explore the value of IL-6 in DTC clinical diagnosis and treatment strategy.Part ⅠObjectiveTo explore the value of IL-6 in the preoperative assessment of DTC,including exploring the relationship between IL-6 and the occurrence,invasion,lymph node metastasis,BRAF V600E gene mutation of DTC primary tumor and its clinical application value.Meterials and MethodsSerum IL-6 were detected by ELISA among 30 DTC patients（29 papillary carcinoma,1 follicular carcinoma）,6 nodular goiter patients and 29 healthy individuals.Results1.The IL-6 level was significant difference among healthy contorl gruop,the group of nodular goiter,and DTC group（F=5.466,P=0.007）.The IL-6 level was significantly higher in DTC group than healthy contorl gruop（P=0.014）and the group of nodular goiter（P=0.007）.But its level was no significant difference between healthy contorl group and the group of nodular goiter（P=0.681）.2.The IL-6 level is not associated with age,sex,TSH,FT3,FT4 in DTC patients.3.According to the pathological findings,local invasion of primary tumors,lymph node metastasis and TNM staging of 30 DTC patients,found that the IL-6 level was significantly higher in T3+T4a group than T1+T2 group（t=-2.509,P=0.018）.The IL-6 level was significantly higher in the lymph node metastasis group than without lymph node metastasis group（t=2.111,P=0.044）,and the IL-6 level was significantly higher in the primary tumor invading thyroid capsule than non-invading thyroid capsule（t=-2.509,P=0.018）.There was no significant difference in IL-6 level between the stage III and stage I of tumor（t=-0.168,P=0.868）.4.Among the 30 patients with DTC,17 were tested for BRAF V600E gene mutations,including 14 mutations and 3 no mutations.There was no significant difference in IL-6 level between these two groups（t=0.452,P=0.658）.Conclusions1.IL-6 level is closely related to the occurrence,invasion,and lymph node metastasis of DTC primary tumors.It can be used as an auxiliary diagnostic index for DTC and provides new ideas and strategies for the diagnosis and treatment.2.The detection of IL-6 levels is not affected by age,sex,and thyroid hormones.It is universal significance to evaluate the condition of DTC patients.3.The relationship between IL-6 and BRAFV600E gene mutation is the further research detection.Part ⅡObjectiveTo explore the serum IL-6 in the clinical diagnosis and treatment strategies in DTC patients underwent total thyroidectomy,including exploring the relationship between serum IL-6 and Tg,TgAb,postoperative metastasis and the changes of IL-6level after 131I treatment.Meterials and MethodsSerum IL-6 were detected by ELISA in 85 DTC patients underwent total thyroidectomy.Among them,46 patients prepare to receive 131I therapy and 39 patients receive TSH suppression after 131I treatment.Among 46 DTC patients underwent total thyroidectomy,preparing to receive 131I therapy with TSH stimulation,there were 3 patients with Tg<1ng/ml and TgAb-positive,14 patients with Tg<1ng/ml and TgAb-negative and 29 patients with Tg>10 ng/ml and TgAb-negative.131I whole body scan was performed in the above patients within 5-7 days after 131I treatment,and 18/46（39.1%）cases were found metastases.Among 39 DTC patients underwent total thyroidectomy,131I treatment and TSH suppression therapy,there were 12 patients with Tg<0.2 ng/ml and TgAb-positive,14patients with Tg<0.2 ng/ml and TgAb-negative,13 patients with Tg>1ng/ml and TgAb-negative(The average time from the last 131I treatment is 258 days).The IL-6 levels were compared between 3-5 days before 131I treatment and 2months after 131I treatment in 18 DTC patients.Results1.When TSH is in stimulated state with TgAb-negative,IL-6 level was significantly lower in the Tg<1ng/ml group than the Tg>10ng/ml group（t=-2.691,P=0.010）.There was no significant differences in TSH level between the two groups（t=-1.680,P=0.101）.2.When TSH is in suppression state with TgAb-negative,there was no significant difference in IL-6 level between Tg<0.2ng/ml group and Tg>1ng/ml group（t=0.770,P=0.939）.There was no significant differences in TSH level between the two groups（t=-1.969,P=0.083）.3.There was no significant difference in IL-6 level between TgAb-positive group and TgAb-negative group（t=-0.191,P=0.850）.There was no significant difference in the time distance to the latest 131I treatment between the two groups（u=0.157,P=0.160）.4.IL-6 level in metastasis group was significantly higher than the non-metastasis group（t=-2.10,P=0.042）.5.There was no significant difference in IL-6 levels before and after 131I treatment in 18 DTC patients（t=-0.850,P=0.407）.Conclusions1.IL-6 level is not affected by TgAb,and is related to Tg in TSH stimulation state.It is helpful to judge the condition of metastasis.Therefore,when the Tg,interfered with TgAb-positive,is difficult to judge the condition of metastasis,IL-6 can be used as an effective index to help judge the condition of metastasis and provide more clinical diagnosis and treatment decision information.2.The relationship between IL-6 and Tg in the TSH suppression state,and changes of IL-6 level before and after 131I treatment need to be further studied,including increasing the sample size,more accurate Tg subgroups,multiple time points detection and prolonging the follow-up time.3.The relationship between the dynamic detection of IL-6 levels and the stratified indicators of Tg and TgAb dynamic risk is the further research direction. |
