摘要目的:探究高细胞亚型及具有高细胞特征的甲状腺乳头状癌(PTC)患者临床病理学特征有无差异及影响其 131I治疗疗效的因素。 方法:回顾性分析2018年1月至2023年6月于青岛大学附属医院核医学科行 131I治疗的84例病理提示高细胞亚型或具有高细胞特征的PTC患者，其中男28例、女56例，年龄43.5(35.0，55.0)岁，按 131I治疗后的疗效评估结果分为结构性疗效不佳(SIR)组和非SIR组。采用Wilcoxon秩和检验、Fisher确切概率法、Mann-Whitney U检验比较组间差异，将 P<0.1的变量纳入logistic多因素回归分析，采用ROC曲线计算刺激性甲状腺球蛋白(sTg)影响疗效的界值。 结果:高细胞亚型组(43例)和高细胞特征组(41例)中，非SIR、SIR患者分别有37、6例和33、8例。在高细胞亚型患者中，sTg在非SIR组和SIR组间差异有统计学意义( Z＝－2.81, P＝0.003)，而性别、年龄、肿瘤多灶性、肿瘤被膜侵犯、T分期、N分期、B-Raf原癌基因丝氨酸/苏氨酸蛋白激酶(BRAF) V600E突变、初始复发风险、淋巴结转移个数及肿瘤最大径差异均无统计学意义( Z值：－0.74~－0.11，均 P>0.05)。在高细胞特征患者中，sTg亦在非SIR组和SIR组间差异有统计学意义( Z＝－4.40, P<0.001)，上述其他临床特征及高细胞占比差异均无统计学意义( Z值：－1.90~－0.22，均 P>0.05)。Logistic多因素回归分析显示，sTg为影响高细胞亚型[(比值比( OR)＝25.156，95% CI: 2.245~281.812， P＝0.009]及高细胞特征( OR＝19.214，95% CI: 2.537~145.502， P＝0.004)患者SIR的独立危险因素。ROC曲线分析得到sTg预测高细胞亚型组SIR的最佳界值为20.75μg/L，预测高细胞特征组SIR的最佳界值为18.55μg/L。 结论:sTg是预测高细胞亚型(sTg≥20.75μg/L)及高细胞特征(sTg≥18.55μg/L)PTC患者SIR的独立危险因素，而其他临床病理学特征在两者间未见明显差异，提示具有高细胞特征的PTC的侵袭性可能并不低于高细胞亚型PTC，亦当引起临床重视。

abstractsObjective:To explore the clinicopathologic features differences between tall cell variant of papillary thyroid cancer (TCV-PTC) and PTC with tall cell features (PTC-TCF) and the factors influencing efficacy of 131I therapy in patients with TCV-PTC and PTC-TCF. Methods:A retrospective analysis was conducted on 84 patients (28 males, 56 females, age 43.5(35.0, 55.0) years) with pathologically confirmed TCV-PTC or PTC-TCF and who were treated with 131I therapy from January 2018 to June 2023 in the Department of Nuclear Medicine, the Affiliated Hospital of Qingdao University. The patients were divided into structural incomplete response (SIR) group and non-SIR group according to 131I treatment response. Data differences were analyzed by Wilcoxon rank sum test, Fisher exact test, or Mann-Whitney U test. Variables with P<0.1 were enrolled in logistic multivariate regression analysis. The ROC curve was used to obtain the cut-off value of stimulated thyroglobulin (sTg). Results:A total of 37 patients with non-SIR and 6 patients with SIR were found in TCV-PTC group ( n=43), and 33 non-SIR and 8 SIR cases were found in PTC-TCF group ( n=41). Univariate analysis revealed that sTg differed significantly between non-SIR patients and SIR patients in TCV-PTC group ( Z=-2.81, P=0.003), while no significant differences observed for sex, age, multifocality, capsular invasion, T stage, N stage, B-Raf proto-oncogene, serine/threonine-protein kinase (BRAF) V600E mutation, initial recurrence risk, number of metastatic lymph nodes, maximum tumor diameter ( Z values: from -0.74 to -0.11, all P>0.05). In TCV-PTC group, sTg also differed significantly between non-SIR patients and SIR patients ( Z=-4.40, P<0.001), while the other clinical factors above and the proportion of tall cells showed no significant difference ( Z values: from -1.90 to -0.22, all P>0.05). The logistic regression analysis confirmed sTg as an independent risk factor of SIR in both TCV-PTC group (odds ratio ( OR) = 25.156, 95% CI: 2.245-281.812, P=0.009) and PTC-TCF group ( OR=19.214, 95% CI: 2.537-145.502, P=0.004). The ROC curve indicated that the cut-off value of sTg for predicting SIR was 20.75μg/L in TCV-PTC group and 18.55μg/L in PTC-TCF group. Conclusions:sTg is the independent risk factor for predicting the poor prognosis of patients with TCV-PTC (sTg≥20.75μg/L) and PTC-TCF (sTg≥18.55μg/L). However, other clinical characteristics show no statistical difference between TCV-PTC group and PTC-TCF group, suggesting that the invasiveness of PTC-TCF may not be lower than that of TCV-PTC, which close attention should be paid to in clinical practice.