131I治疗分化型甲状腺癌肺转移的疗效评价及影响因素探讨  

Curative efficacy and influential factors of 13aI treatment for lung metastases from differentiated thy- roid carcinoma

作　　者：王任飞[1] 谭建[1] 张桂芝[1] 郑薇[1] 何雅静[1] 李承霞[1] 

机构地区：[1]天津医科大学总医院核医学科,300052

出　　处：《中华核医学与分子影像杂志》2015年第4期258-261,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家临床重点专科建设项目

摘　　要：目的评价131I治疗DTC肺转移的疗效，并分析影响疗效的相关因素。方法回顾性分析2007年10月至2012年12月间接受131I治疗的50例DTC肺转移患者[男18例，女32例，平均年龄（40．8±13．2）岁]，治疗后6个月以rrg结合131I显像等评价131I疗效，对可能影响疗效的年龄、性别、DTC术式、病理学类型、确诊肺转移时间、确诊时Tg水平、摄131I形态、其他影像学检查发现、颈部淋巴结转移和肺外远处转移（有转移赋值1，无转移赋值0）等10个因素进行单因素（独立样本t检验及Fisher确切概率法）和多因素分析（10gistic回归）。结果131I治疗DTC肺转移的治愈率为20％（10／50），有效率74％（37／50），无效率26％（13／50）。单因素分析结果显示：患者年龄（t=2．019，P〈0．05）、性别（P=0．032）、确诊肺转移时Tg水平（t=2．646，P〈0．05）、其他影像学检查发现（P=0．039）及肺外远处转移（P=0．023）5个因素与疗效相关；进一步的多因素分析结果显示：患者年龄、确诊肺转移时Tg水平以及肺外远处转移是影响131I治疗DTC肺转移的确定性因素。回归方程：LogitP=2．127—0．056X年龄-0．163XTg水平-1．280X肺外远处转移（χ2=10．484，P〈0．001）。患者年龄越大、确诊肺转移时Tg水平越高以及合并肺外远处转移，131I治疗DTC肺转移的疗效越差。结论131I治疗DTC肺转移疗效确切；DTC肺转移患者中，年龄轻、确诊时Tg水平低以及无肺外远处转移的患者131I治疗效果好。Objective To investigate the efficacy and influential factors of 131I treatment for lung metastases from DTC. Methods Fifty patients （18 males, 32 females; age （40.8±13.2） years） with lung metastases from DTC who underwent 131I treatment from October 2007 to December 2012 were retrospectively analyzed. The efficacy of 131I treatment was assessed using 131I imaging and determination of serum Tg level after 6 months. The possible factors affecting efficacy included patients＇ age, gender, operation method, pathological classification, the diagnostic time of pulmonary metastasis, serum Tg level at diagnosis, 1311 up- take pattern, characteristics of other imaging modalities, cervical lymph node metastases and extrapulmonary distant metastases （assign 1 for metastases, 0 for no metastases ）. Univariate and multivariate analyses （Student t test, Fisher exact test and logistic regression） were performed to investigate the factors. Results The rates of complete remission, partial response and invalid of 131I treatment were 20% （10/50）, 74% （37/50） and 26% （13/50） respectively. Univariate analysis showed that age （ t = 2.019, P〈O.05）, gender （P=0.032）, serum Tg level at diagnosis（t=2.646, P〈0.05）, findings of other imaging modalities （P= 0. 039）, and extrapulmonary distant metastases （P = 0. 023） were the factors influencing outcome of ~31I treatment. Multivariate logistic regression analysis showed that the influential factors included age, serum Tg levels and extrapulmonary distant metastases. The regression equation was as follows： logit P= 2.127-0.056X age-0.163xTg level- 1.280extrapulmonary distant metastasis （χ2 = 10.484, P〈0.001 ）. Aged patients, a significant increase of Tg level and extrapulmonary distant metastases indicated a poor prognosis. Conclusions 131I treatment is an effective method for lung metastases from DTC. The patients with younger age, lower Tg levels, no other distant metastases had good response to 1hi treatment.

关 键 词：甲状腺肿瘤 放射疗法 碘放射性同位素 

分 类 号：R736.1[医药卫生—肿瘤]