分化型甲状腺癌术后~131Ⅰ治疗生存率分析  

Survival of patients with differentiated thyroid carcinoma after thyroidectomy and ~131I therapy

作　　者：余永利[1] 罗全勇[1] 陈立波[1] 罗琼[1] 丁颖[1] 陆汉魁[1] 朱瑞森[1] 马寄晓[1] 

机构地区：[1]上海交通大学附属第六人民医院核医学科,200233

出　　处：《中华核医学杂志》2006年第5期261-263,共3页Chinese Journal of Nuclear Medicine

基　　金：上海市科技发展基金(024119053)

摘　　要：目的总结和分析分化型甲状腺癌(DTC)术后^(131)Ⅰ治疗的生存率变化。方法①1991～2003年收治 DTC 术后患者566例,按转移部位分组为颈淋巴结转移356例,肺转移128例和骨转移82例。②本院外科1991～2003年 DTC 术后随访患者198例,均未行^(131)Ⅰ清除术后剩余甲状腺(简称清甲)或治疗转移灶,仅接受术后 TSH 抑制(T_4)治疗。③本科1991～2003年收治 DTC 术后即行^(131)Ⅰ清甲者194例,术后2～6周即行^(131)Ⅰ清甲及后续转移灶^(131)Ⅰ治疗,并辅以 TSH 抑制(T_4)治疗。④根据寿命表法,分别计算各组(无死亡)生存率、无疾病生存率、无进展生存率和无复发生存率,分析其变化。结果①所有患者^(131)Ⅰ治疗后10年(无死亡)生存率为92.38%。②颈淋巴结转移组10年(无死亡)生存率为98.09%,肺转移组87.50%,骨转移组80.41%;近端(颈淋巴结)转移组(无死亡)生存率明显高于远端(肺或骨)转移组(X^2=4.074,P<0.05)。③手术+^(131)Ⅰ+T4治疗组无复发生存率、无进展生存率和无疾病生存率明显高于手术+T_4组(X^2均>3.84,P<0.05)。结论 ^(131)Ⅰ治疗可明显提高患者无复发生存率、无进展生存率和无疾病生存率。Objective The aim of the retrospective study was to analyze the survival of patients with differentiated thyroid carcinoma （DTC） after thyroidectomy with or without ^131I therapy. Methods Of 566 DTC clinically followed up from 199l to 2003, 356 cases were diagnosed with cervical lymph node metastases, 128 with pulmonary and 82 with bone metastases. After initial thyroidectomy, 194 cases underwent ^131I-ablating therapy for remnant thyroid and serial ^131I therapy for DTC metastases, followed by thyroxine （T4） suppression therapy, while 198 cases received merely thyroxine （T4 ） suppression therapy. Statistical methods of survival expectancy table were carried out to analyze death-free survival, recurrence-free survival, progress-free survival and disease-free survival for DTC. Results（1）The 10 years death-free survival rate of all DTC patients was 92.38%. （2）The 10 years death-free survival rate was 98.09% for DTC with cervical lymph node metastases, significantly higher than those with pulmonary metastases （87.50%） and bone metastases （ 80.41% , x^22 = 4. 074, P 〈 0.05 ）. （3）Recurrence-free survival, progress-free survival and disease-free survival rates of patients treated with thyroidectomy ＋ ^131I ＋ T4 therapy were significantly higher than those with thyroidectomy ＋ T4 therapy only （x^2 〉 3.84, P 〈 0.05 ）. Conclusion ^131I therapy after thyroidectomy may effectively improve recurrence-free survival, progress-free survival and disease-free survival rates for DTC patients.

关 键 词：甲状腺肿瘤 手术后期间 碘放射性同位素 放射疗法 预后 

分 类 号：R736.1[医药卫生—肿瘤]