区分甲状腺癌中的TSH切断和复发风险:系统性审查和元分析
Yoon Young Cho1, Soo Hyun Ahn2, Mijin Kim3
1Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea.
The Journal of clinical endocrinology and metabolism
|August 14, 2025
概括
抑制甲状腺刺激激素 (TSH) 总体上没有显著影响差异化甲状腺癌复发. 然而,TSH抑制可能会降低远程转移的高风险患者的复发风险.
科学领域:
- 内分泌学 在内分泌学.
- 在瘤学瘤学.
- 临床研究 临床研究
背景情况:
- 差异化甲状腺癌 (DTC) 管理通常涉及TSH抑制.
- 最佳的TSH水平以最大限度地降低复发风险仍在争论中.
- 美国甲状腺协会 (ATA) 分层了DTC复发风险.
研究的目的:
- 评估TSH水平与DTC复发风险之间的关联.
- 根据可变的TSH切断值 (0.1,0.5,2.0 mIU/L) 来分析复发率.
- 根据ATA风险类别分层调查TSH的作用.
主要方法:
- 在Ovid-Medline,EMBASE和Cochrane数据库中进行系统搜索 (截至2024年3月).
- 包括随机对照试验和观察性研究.
- 基于TSH切线和ATA风险分层的元分析和子组分析.
主要成果:
- 对5320名患者的分析,整体复发率为18%.
- 在TSH切断值 (0.1,0.5,2.0 mIU/L) 中,聚合复发风险没有显著差异.
- 在敏感性分析中,在TSH ≥0.1 mIU/L和TSH ≥2.0 mIU/L时观察到复发风险增加;在TSH ≥0.1 mIU/L时,患有远程转移的患者 (HR 3.3) 的风险更高.
结论:
- TSH抑制程度没有影响整体DTC复发.
- 对于具有远程转移的高风险DTC患者来说,TSH抑制可能是有益的.
- 进一步的研究可能会澄清TSH在特定患者亚组中的作用.
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