基于分析灵敏度的可检测抗甲状腺球蛋白抗体在放射性碘治疗后血清甲状腺球蛋白不可测的乳头状甲状腺癌中的预后意义
该回顾性研究纳入1039例≥1 cm的乳头状甲状腺癌患者，均在甲状腺全切加放射性碘消融治疗后6-12个月时无刺激血清甲状腺球蛋白不可测（<0.2 ng/mL）。按参考上限（60.0 U/mL）和定量下限（LOQ，43.4 U/mL）将同期测定的TgAb分为不可测、临界和升高三组，中位随访12.0年。
要点
- 基于LOQ分类的TgAb临界组（43.4-60.0 U/mL）较不可测组复发风险显著增高（校正HR 2.01）。
- 三组10年无进展生存率分别为97.9%、94.6%和88.5%（p<0.001）。
- 临界组中75.0%患者TgAb在6.3年内转为不可测，持续临界者复发率12.9%（p=0.01）。
核心结论
- 在放射性碘治疗后血清Tg不可测的PTC患者中，TgAb水平高于LOQ与更高的复发风险相关。
- 基于LOQ的TgAb阳性分类可能较传统参考上限改善预后评估。
研究设计与样本
- 回顾性分析2009-2012年1039例≥1 cm的PTC患者，均行甲状腺全切加RAI消融，术后6-12个月无刺激血清Tg<0.2 ng/mL。
- 同期TgAb按参考上限60.0 U/mL和LOQ 43.4 U/mL分为不可测（<43.4 U/mL）、临界（43.4-60.0 U/mL）和升高（>60.0 U/mL）三组。
- 中位随访12.0年。
主要发现
- 中位年龄48.2岁，男性188例（18.1%）；中位肿瘤大小1.5 cm；淋巴结转移705例（67.8%）。
- 随访期间复发率4.8%。
- 初始TgAb分类：不可测65.6%、临界23.5%、升高10.9%，对应10年无进展生存率97.9%、94.6%、88.5%（p<0.001）。
- 临界组中75.0%患者TgAb在6.3年内转为不可测，持续临界者复发率12.9%（p=0.01）。
关键数值与推荐
- TgAb参考上限为60.0 U/mL，LOQ为43.4 U/mL，据此分为不可测（<43.4 U/mL）、临界（43.4-60.0 U/mL）和升高（>60.0 U/mL）。
- 无刺激血清Tg不可测定义为<0.2 ng/mL。
临床怎么用
- 对RAI治疗后血清Tg不可测的PTC患者，可采用基于LOQ的TgAb分类细化复发风险分层。
- TgAb处于临界范围（43.4-60.0 U/mL）的患者应加强随访监测。
- 临界组中多数患者TgAb可转为不可测，持续临界者复发风险更高，需个体化评估。
局限性
- 原文为回顾性研究，需进一步研究验证发现并优化TgAb阈值。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: Serum thyroglobulin (Tg) is a key tumor marker in papillary thyroid carcinoma (PTC), but its reliability may be compromised by the presence of antithyroglobulin antibodies (TgAb). Utilizing the assay-specific limit of quantification (LOQ) may enhance the detection of TgAb-related interference compared with the traditional reference limit. This study evaluated postoperative TgAb levels based on LOQ as a surrogate marker for tumor monitoring in PTC. METHODS: A total of 1039 patients with PTC (≥1 cm) who had undetectable unstimulated serum Tg (<0.2 ng/mL) 6-12 months after total thyroidectomy with radioactive iodine (RAI) ablation therapy (2009-2012) were retrospectively analyzed. Simultaneously measured TgAb levels were classified using both the reference limit (60.0 U/mL) and LOQ (43.4 U/mL) into three groups undetectable (<43.4 U/mL), borderline (43.4-60.0 U/mL), and elevated (>60.0 U/mL). RESULTS: The median age was 48.2 years, and 188 (18.1%) were male. The median tumor size was 1.5 cm, and lymph node metastases were present in 705 patients (67.8%). During a median follow-up of 12.0 years, recurrence occurred in 4.8%. Based on initial TgAb level, patients were classified as undetectable (65.6%), borderline (23.5%), and elevated (10.9%), with corresponding 10-year progression-free survival rates of 97.9%, 94.6%, and 88.5%, respectively (p < 0.001). Multivariable analysis revealed a significantly higher recurrence risk in the borderline group compared with the undetectable group (adjusted hazard ratio, 2.01; confidence interval, 1.03-3.96; p = 0.043). In the borderline group, TgAb became undetectable in 75.0% of patients over 6.3 years, whereas those who remained borderline exhibited a higher recurrence rate of 12.9% (p = 0.01). CONCLUSIONS: TgAb levels above the LOQ were associated with a higher recurrence risk in patients with PTC with undetectable Tg after RAI treatment. Classification of TgAb positivity based on the LOQ may improve prognostic assessment compared with evaluation using conventional reference limits. Further studies are needed to validate our findings and refine TgAb thresholds.
引用
- Kim CA, Kim YI, Lee DY, et al. Prognostic Significance of Detectable Antithyroglobulin Antibodies Based on Analytical Sensitivity in Papillary Thyroid Carcinoma with Undetectable Serum Thyroglobulin after Radioactive Iodine Treatment. Thyroid. 2026. PMID: 42225640. doi:10.1177/10507256261457026
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。