中国癌症杂志 ›› 2019, Vol. 29 ›› Issue (3): 207-211.doi: 10.19401/j.cnki.1007-3639.2019.03.008

• 论著 • 上一篇    下一篇

中低危分化型甲状腺癌低剂量131I治疗后短期转归的临床分析

宋娟娟1,2,刘延晴1,林岩松1   

  1. 1. 中国医学科学院北京协和医学院北京协和医院核医学科,北京100730 ;
    2. 北京大学国际医院核医学科,北京 102206
  • 出版日期:2019-03-30 发布日期:2019-04-26
  • 通信作者: 林岩松 E-mail: linyansong1968@163.com
  • 基金资助:
    国家自然科学基金(81571714,81771875)。

Clinical analysis of short-term outcome in low-to-intermediate-risk thyroid cancer after low-dose 131I therapy

SONG Juanjuan1,2, LIU Yanqing1, LIN Yansong1   

  1. 1. Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; 2. Department of Nuclear Medicine, Peking University International Hospital, Beijing 102206, China
  • Published:2019-03-30 Online:2019-04-26
  • Contact: LIN Yansong E-mail: linyansong1968@163.com

摘要: 背景与目的:2015版美国甲状腺协会(American Thyroid Association,ATA)指南首次提出治疗反应评估体系(response-to-therapy assessment system,RTAS)。该研究根据此评估体系,探讨低剂量(1 110 MBq)131I在中低危分化型甲状腺癌(differentiated thyroid carcinoma,DTC)清甲治疗后短期内不同转归的影响因素。方法:回顾性分析2015年1月—2017年1月166例中低危DTC患者资料,男性50例,女性116例,平均年龄(39.61±10.23)岁。首次清甲剂量为1 110MBq,取得清甲前及清甲后6~12个月刺激性甲状腺球蛋白(stimulated thyroglobulin,sTg)及诊断性全身显像(diagnosticwhole body scan,Dx-WBS),根据结果分为最佳治疗反应(excellent response,ER)组与非最佳反应(non-excellent response,NER)组。采用两样本t检验、Mann-Whitney U秩和检验及χ2检验进行组间临床病理资料比较,采用Logistic回归分析影响清甲疗效的因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线确定最佳界值。结果:ER组127例,NER组39例,ER率为76.5%(127/166)。治疗后短期随访ER组清甲治疗前sTg(preablative sTg,ps-Tg)明显低于NER组[1.5(0.04-30.57)ng/mL vs 17.6(0.04-21.52)ng/mL;U=2 479,P<0.05],且性别、年龄差异有统计学意义,男性及年龄稍小者更易出现NER。多因素分析显示,ps-Tg水平、肿瘤大小、淋巴结转移数目、性别、年龄及多灶性均为影响清甲疗效的相关因素(OR:0.361~2.875)。ROC曲线分析显示,ps-Tg最佳临界值为2.0 ng/mL。结论:ps-Tg水平较低、病灶较小、淋巴结转移数目较少、男性、年龄较小及单灶患者清甲治疗后短期内更易达到ER;且以ps-Tg值2.0 ng/mL为最佳临界点,对预测治疗后短期临床转归有较高的灵敏度和特异度。

关键词: 分化型甲状腺癌, 131I治疗, 治疗反应, 甲状腺球蛋白

Abstract: Background and purpose: The concept of response-to-therapy assessment system (RTAS) was first proposed in the 2015 American Thyroid Association (ATA) guidelines. This study aimed to investigate the different short-term outcomes of thyroid ablation with low-dose (1 110 MBq) 131I for low-to-intermediate-risk thyroid cancer based on this system, and its probable influence factors. Methods: A total of 166 patients with differentiated thyroid carcinoma (DTC) [50 males, 116 females; average age: (39.61±10.23) years] undergoing first thyroid ablation with 1 100 MBq 131I from January 2015 to January 2017 were retrospectively observed. All patients underwent diagnostic whole body scan (Dx-WBS), and the stimulated thyroglobulin (sTg) was measured before ablation and 6-12 months after ablation respectively. According to above results, patients were divided into excellent response (ER) group and non-excellent response (NER) group. Clinical and pathological characteristics of 2 groups were compared using two-sample t test, Mann-Whitney U test and χ2 test. Logistic regression was used to identify the influence factors for efficacy of 131I ablation, and the cut-off value was determined by receiver operating characteristic (ROC) curve analysis. Results: There were 127 patients in ER group and 39 patients in NER group. The successful ablation rate was 76.5% (127/166). Patients in ER group showed lower preablative sTg (ps-Tg) compared with patients in NER group. The ps-Tg levels were 1.5 (0.04-30.57) ng/mL and 17.6 (0.04- 21.52) ng/mL respectively (U=2 479, P<0.05). Male and patient with younger age were more prevalent in NER group (P<0.05). Logistic regression showed that ps-Tg, tumor size, the number of metastatic lymph nodes, gender, age and multifocality were independent predictors for efficacy of 131I ablation (OR: 0.361-2.875). The optimal cut-off value of ps-Tg identified by ROC curve analysis was 2.0 ng/mL. Conclusion: The patients with lower ps-Tg, smaller diameter of tumor, fewer lymph node metastases, male, younger age and single lesion are more likely to have ER within a short period following thyroid ablation. Ps-Tg of 2.0 ng/mL is identified as cut-off value for predicting the short-term therapeutic response, which has preferable sensitivity and specificity.

Key words: Differentiated thyroid cancer, 131I therapy, Response-to-therapy, Thyroglobulin