<sup>131</sup>I治疗45岁以下分化型甲状腺癌的疗效及影响因素

doi:10.3877/cma.j.issn.1674-3946.2023.06.012

目的

探讨¹³¹I治疗45岁以下分化型甲状腺癌的疗效以及影响治疗效果的因素。

方法

回顾分析2019年至2021年间收治的50例¹³¹I治疗45岁以下分化型甲状腺癌患者资料。根据消融效果分为完全消融组（n=32）和不完全消融组（n=18）。数据采用SPSS 22.0软件进行统计分析。符合正态分布的计量资料用（）表示，行独立样本t检验；计数资料采用x²检验。并对单因素分析筛选出的¹³¹I治疗效果的影响因素进行多因素Logistic回归分析。P<0.05为差异有统计学意义。

结果

服用¹³¹I后，出现消化道症状4例，以恶心呕吐为主要表现，对症处理后缓解。颈部出现酸胀感3例，后自行缓解。随访1年，生存率为100%。肿瘤最大径、分期、治疗前甲状腺球蛋白（Tg）、治疗前甲状腺摄碘率（RAIU）两组患者比较差异有统计学意义（P=0.044、P=0.002、P=0.001、P=0.042）；多因素分析显示肿瘤分期、治疗前Tg、治疗前RAIU水平与不完全消融显著相关（P=0.019、P=0.011、P=0.047）。

结论

¹³¹I治疗45岁以下分化型甲状腺癌受多种因素的影响，其中肿瘤分期、治疗前Tg以及治疗前RAIU水平是影响治疗的独立危险因素。

关键词: 甲状腺肿瘤, 分化型, 碘¹³¹, 影响因素分析

Objective

To investigate the efficacy of ¹³¹I in the treatment of differentiated thyroid carcinoma under 45 years old and the influencing factors.

Methods

Data of 50 patients with differentiated thyroid cancer under 45 years of age treated with 131I from 2019 to 2021 were retrospectively analyzed. According to the ablation effect, the two groups were divided into complete ablation group (n=32) and incomplete ablation group (n=18). SPSS 22.0 software was used for statistical analysis. Measurement data conforming to normal distribution were represented by () and independent sample t test was performed. Counting data were tested by χ² . Multivariate Logistic regression analysis was carried out on the influencing factors of 131I treatment effect screened by single factor analysis. P < 0.05 was considered statistically significant.

Results

After taking ¹³¹I, 4 cases had gastrointestinal symptoms, mainly nausea and vomiting, which were relieved after symptomatic treatment. There were 3 cases of sore distension in the neck, which was relieved by itself. After 1year of follow-up, the survival rate was 100%. There were significant differences in tumor maximum diameter, stage, thyroglobulin (Tg) before treatment and thyroid iodine uptake rate (RAIU) between the two groups (P=0.044, P=0.002, P=0.001, P=0.042). Multivariate analysis showed that tumor stage, Tg before treatment, RAIU level before treatment were significantly correlated with incomplete ablation (P=0.019, P=0.011, P=0.047).

Conclusion

¹³¹I treatment of differentiated thyroid cancer under 45 years of age is affected by multiple factors, among which tumor stage, pre-treatment Tg and pre-treatment RAIU level are independent risk factors affecting treatment.

Key words: Thyroid Neoplasms, Differentiated Type, ¹³¹I, Root Cause Analysis

表1 50例45岁以下分化型甲状腺癌 ¹³¹I消融治疗的单因素分析[(),例]

因素	变量	完全消融组（n=32）	不完全消融组（n=18）	统计值	P值
年龄(岁)		33.2±2.4	35.1±3.2	-1.937	0.057
性别	男	7	5	3.452	0.087
	女	25	13
组织学病理	PTC	29	12	0.623	0.113
	FTC	3	6
手术方式	全切	24	13	0.055	0.853
	近全切	8	5
治疗前TSH水平(mU/L)	≥30	23	11	0.365	0.776
	<30	9	7
治疗前RAIU(%)		6.7±5.0	15.2±11.7	-3.895	0.042
肿瘤分期	I期	30	8	20.437	0.002
	II期	2	10
肿瘤最大径(cm)	>2	20	4	4.386	0.044
	≤2	12	14
治疗前TgAb (IU/ml)	≥30	10	6	0.498	0.658
	<30	22	12
治疗前Tg (ng/ml)		22.6±17.3	79.1±31.7	-5.114	0.001
复发危险度分层	中危	19	10	4.226	0.055
	高危	13	8

表1 50例45岁以下分化型甲状腺癌 ¹³¹I消融治疗的单因素分析[(),例]

因素	变量	完全消融组（n=32）	不完全消融组（n=18）	统计值	P值
年龄(岁)		33.2±2.4	35.1±3.2	-1.937	0.057
性别	男	7	5	3.452	0.087
	女	25	13
组织学病理	PTC	29	12	0.623	0.113
	FTC	3	6
手术方式	全切	24	13	0.055	0.853
	近全切	8	5
治疗前TSH水平(mU/L)	≥30	23	11	0.365	0.776
	<30	9	7
治疗前RAIU(%)		6.7±5.0	15.2±11.7	-3.895	0.042
肿瘤分期	I期	30	8	20.437	0.002
	II期	2	10
肿瘤最大径(cm)	>2	20	4	4.386	0.044
	≤2	12	14
治疗前TgAb (IU/ml)	≥30	10	6	0.498	0.658
	<30	22	12
治疗前Tg (ng/ml)		22.6±17.3	79.1±31.7	-5.114	0.001
复发危险度分层	中危	19	10	4.226	0.055
	高危	13	8

表2 45岁以下分化型甲状腺癌¹³¹I消融治疗的多因素Logistic回归分析

因素	β值	OR值	95%CI	P值
年龄	0.921	1.015	0.824-1.774	0.338
肿瘤分期	1.043	0.093	0.045-0.738	0.019
肿瘤最大径(cm)	0.865	0.821	0.011-4.582	0.492
治疗前Tg(ng/ml)	1.012	0.749	0.553-1.074	0.011
治疗前RAIU (%)	1.106	0.692	0.489-0.951	0.047

表2 45岁以下分化型甲状腺癌¹³¹I消融治疗的多因素Logistic回归分析

因素	β值	OR值	95%CI	P值
年龄	0.921	1.015	0.824-1.774	0.338
肿瘤分期	1.043	0.093	0.045-0.738	0.019
肿瘤最大径(cm)	0.865	0.821	0.011-4.582	0.492
治疗前Tg(ng/ml)	1.012	0.749	0.553-1.074	0.011
治疗前RAIU (%)	1.106	0.692	0.489-0.951	0.047

[1]	田文，姚京. 分化型甲状腺癌术前分期与术式选择[J/CD]. 中华普外科手术学杂志（电子版）, 2016, 10(05): 565-567.
[2]	段佐平，廖荣波，杨显金，等. 甲状腺癌组织中Skp2和Cx43的表达与患者临床病理特征的关系[J/CD]. 中华普外科手术学杂志（电子版）, 2019, 13(03): 266-269.
[3]	Luo M，Hu Y. Efficacy of 131I therapy and its influencing factors in children and adolescents with differentiated thyroid carcinoma[J]. J BUON, 2021, 26(3): 1028-1033.
[4]	李涛，焦良和，朱正才，等. 三种手术方式治疗cT1N0期甲状腺癌的近期疗效及安全性比较[J/CD]. 中华普外科手术学杂志（电子版）, 2020, 14(06): 624-627.
[5]	Bashir K，Sarwar R，Fatima S，et al. Haplotype analysis of XRCC1gene polymorphisms and the risk of thyroid carcinoma[J]. J BUON, 2018, 23(1): 234-243.
[6]	Mitsutake N，Knauf JA，Mitsutake S，et al. Conditional BRAFV600E expression induces DNA synthesis，apoptosis，dedifferentiation，and chromosomal instability in thyroid PCCL3cells[J]. Cancer Res, 2005, 65(6): 2465-2473.
[7]	Durante C，Costante G，Filetti S. Differentiated thyroid carcinoma: defining new paradigms for postoperative management[J]. Endocr Relat Cancer, 2013, 20(4): R141-R154.
[8]	Prabhu M，Samson S，Reddy A，et al. Role of Preablative Stimulated Thyroglobulin in Prediction of Nodal and Distant Metastasis on Iodine Whole-Body Scan[J]. Indian J Nucl Med, 2018, 33(2): 93-98.
[9]	Demidchik YE，Demidchik EP，Reiners C，et al. Comprehensive clinical assessment of 740cases of surgically treated thyroid cancer in children of Belarus[J]. Ann Surg, 2006, 243(4): 525-532.
[10]	Parisi MT，Mankoff D. Differentiated pediatric thyroid cancer: correlates with adult disease，controversies in treatment[J]. Semin Nucl Med, 2007, 37(5): 340-356.
[11]	Kuo SF，Chao TC，Chang HY，et al. The role of radioactive iodine therapy in young patients with papillary thyroid cancer[J]. Clin Nucl Med, 2009, 34(1): 4-6.
[12]	Durante C，Haddy N，Baudin E，et al. Long-term outcome of 444patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy[J]. J Clin Endocrinol Metab, 2006, 91(8): 2892-2899.
[13]	Avram AM，Rosculet N，Esfandiari NH，et al. Differentiated Thyroid Cancer Outcomes After Surgery and Activity-Adjusted 131I Theragnostics[J]. Clin Nucl Med, 2019, 44(1): 11-20.
[14]	Dehbi HM，Mallick U，Wadsley J，et al. Recurrence after low-dose radioiodine ablation and recombinant human thyroid-stimulating hormone for differentiated thyroid cancer（HiLo）: long-term results of an open-label，non-inferiority randomised controlled trial[J]. Lancet Diabetes Endocrinol, 2019, 7(1): 44-51.
[15]	Pawelczak M，David R，Franklin B，et al. Outcomes of children and adolescents with well-differentiated thyroid carcinoma and pulmonary metastases following ¹³¹I treatment: a systematic review[J]. Thyroid, 2010, 20(10): 1095-1101.
[16]	Tuttle RM，Ahuja S，Avram AM，et al. Controversies，Consensus，and Collaboration in the Use of（131）I Therapy in Differentiated Thyroid Cancer: A Joint Statement from the American Thyroid Association，the European Association of Nuclear Medicine，the Society of Nuclear Medicine and Molecular Imaging，and the European Thyroid Association[J]. Thyroid, 2019, 29(4): 461-470.
[17]	van DD，Plukker JTM，van der Horst-Schrivers ANA，et al. The value of detectable thyroglobulin in patients with differentiated thyroid cancer after initial ¹³¹I therapy[J]. Clin Endocrinol（Oxf）, 2011, 74(1): 104-110.
[18]	中华医学会内分泌学分会，中华医学会外科学分会内分泌学组，中国抗癌协会头颈肿瘤专业委员会，等. 甲状腺结节和分化型甲状腺癌诊治指南[J]. 中华核医学与分子影像杂志, 2013, 33(02): 96-115.
[19]	Tian T，Xu Y，Zhang X，et al. Prognostic Implications of Preablation Stimulated Tg: A Retrospective Analysis of 2500Thyroid Cancer Patients[J]. J Clin Endocrinol Metab, 2021, 106(11): e4688-e4697.
[20]	Haugen BR，Alexander EK，Bible KC，et al. 2015American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer[J]. Thyroid, 2016, 26(1): 1-133.
[21]	Tuttle RM，Haugen B，Perrier ND. Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System for Differentiated and Anaplastic Thyroid Cancer（Eighth Edition）: What Changed and Why?[J]. Thyroid, 2017, 27(6): 751-756.
[22]	Cooper DS，Doherty GM，Haugen BR，et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid, 2009, 19(11): 1167-1214.

[1]	高玲, 于哲, 范然, 臧银善. 外周血细胞计数比值评估类风湿关节炎疗效的价值[J]. 中华关节外科杂志(电子版), 2023, 17(05): 642-647.
[2]	陈絮, 詹玉茹, 王纯华. 孕妇ABO血型联合甲状腺功能检测对预测妊娠期糖尿病的临床价值[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 604-610.
[3]	王蓓蓓, 董启秀, 郗红燕, 于庆云, 张丽君, 式光. 早孕期孕妇药物流产失败的影响因素分析与构建相关预测模型及其对药物流产成功的预测价值[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 588-594.
[4]	王鹏, 肖厚安, 贾赤宇. 不同因素调控巨噬细胞极化在慢性难愈性创面中的研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(05): 454-459.
[5]	李永浩, 高雪菲, 郭田田, 张进, 张彩针, 刘静. 肥胖合并甲状腺癌相关机制的研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(04): 311-315.
[6]	杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[7]	甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[8]	袁育韬, 邢金琳, 谢克飞, 殷凯. CT征象及BRAF^V600E基因突变与甲状腺乳头状癌中央区淋巴结转移的相关性[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 611-614.
[9]	崔占斌, 乔军利, 张丽丽, 韩明强. 尿碘水平与甲状腺乳头状癌患者术后复发危险度分层的相关性[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 615-618.
[10]	陈垚, 徐伯群, 高志慧. 改良式中间上入路根治术治疗甲状腺癌的有效性安全性研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 619-622.
[11]	江振剑, 蒋明, 黄大莉. TK1、Ki67蛋白在分化型甲状腺癌组织中的表达及预后价值研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 623-626.
[12]	樊丽超, 郭瑾瑛, 陈鑫. 野生型RET与RET/PTC融合基因检测对甲状腺乳头状癌中央区淋巴结清扫的指导意义[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 631-635.
[13]	徐成, 王璐璐, 王少华. 洗脱液甲状腺球蛋白在甲状腺乳头状癌转移淋巴结中的应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 701-704.
[14]	汪毅, 许思哲, 任章霞. 胸乳入路腔镜单侧甲状腺叶切除术与开放手术对分化型甲状腺癌患者术后恢复的影响[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 542-545.
[15]	张蓉, 秦洪真, 杨晓冬, 刘爽, 刘明锋, 曹秀堂. 分化型甲状腺癌术后康复锻炼的临床应用研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(04): 439-442.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Efficacy and influencing factors of ¹³¹I in the treatment of differentiated thyroid carcinoma under 45 years old

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Efficacy and influencing factors of 131I in the treatment of differentiated thyroid carcinoma under 45 years old

Efficacy and influencing factors of ¹³¹I in the treatment of differentiated thyroid carcinoma under 45 years old