分化型甲状腺癌肺转移患者-131Ⅰ治疗临床数据分析  

作　　者：易贺庆[1] 张丽军[1] 陈授聪 龙斌[1] 叶雪梅[1] 李林法[1] 

机构地区：[1]浙江省肿瘤医院核医学科(浙江省头颈肿瘤转化医学研究重点实验室),310021

出　　处：《浙江临床医学》2018年第6期994-996,共3页Zhejiang Clinical Medical Journal

基　　金：国家自然科学基金青年科学基金项目（81502318）

摘　　要：目的通过随访分析分化型甲状腺癌（DTC）肺转移患者-131Ⅰ治疗的临床资料，探讨影响DTC肺转移患者-131Ⅰ疗效、发展及转归因素。方法从2007年1月至2011年12月给予-131Ⅰ治疗的5361例DTC患者中筛选单纯肺转移患者，随访〉5年，观察患者疾病的发生、发展及转归。分析影响患者-131Ⅰ疗效及生存的因素。结果符合筛选条件的患者共109例，男43例，女66例。肺部转移灶摄Ⅰ患者79例，不摄1的患者30例。疗效评价完全缓解（CR）患者19例（19／109，17．4％），部分有效（PR）患者23例（23／109，21．1％），稳定（SD）患者38例（38／109，34．9％）；PD患者29例，其中摄Ⅰ但疗效评价进展（PD）的患者15例（16／109，13．8％）。年龄和病灶大小与患者的-131Ⅰ治疗疗效相关（P〈0．01，OR值分别为0．056和0.036）；年龄、Tg水平、病灶大小、病灶摄碘情况是影响DTC肺转移患者生存的相关因素（P〈0．05，OR值分别为4．5、O．356、8．8和2．5）。结论-131Ⅰ是治疗DTC的有效手段；-131Ⅰ治疗抵抗涉及碘代谢功能障碍和固有放疗敏感性两个方面；年龄和病灶大小与-131Ⅰ疗效相关；患者年龄、Tg水平、肺部病灶大小、病灶摄碘与否和患者生存相关。Objective To analyze the clinical data of 131Ⅰ treatment in patients with differentiated thyroid carcinoma （DTC） with lung metastasis, and to explore the factors that affect the efficacy, development and prognosis on patients. Methods 109 DTC patients with pulmonary metastases were screened from 5361 DTC patients who accepted 131Ⅰ therapy from January 2007 to December 2011, followed up for more than 5 years. Statistical methods were apphed to analyze the factors affecting 131Ⅰ efficacy and survival in patients. Results A total of 109 patients were collected, in which there were 66 female patients and 43 male patients. 79 patients had pulmonary metastases took iodine, and 30 patients did not take iodine. Patients with complete response （ CR ） were 19 （ 19/109, 17.4% ） , partial response （PR） were 23 （ 23/109, 21.1%） , stable disease （ SD ） were 38 （ 38/109, 34.9% ） . After 131Ⅰ treatment, there were 29 （ 29/109, 26.6% ） patients had progression disease （ PD ） , of which 15 （ 15/109, 13.8% ） patients took iodine but progressing. Age and size of lung lesions were correlated with the efficacy of 131Ⅰ （ P〈0.01, OR=0.056 and 0.036, respectively ） . Age, thyroglobulin （ Tg ） level, size of lung lesions, and iodine uptake of the lesions were the factors affecting the overall survival of patients with DTC pulmonary metastases （P〈0.05, OR=4.5, 0.356, 8.8 and 2.5, respectively ） . Conclusion This study indicates that, 131Ⅰ is an effective measure for DTC pulmonary metastases patients. 131Ⅰ treatment resistance in DTC lesions involves two aspects： dysfunction of iodine metabolism and innate radiation sensitivity. Age at onset and size of lung lesions are correlated with the efficacy of 131Ⅰ therapy. Age, Tg level, size of lung lesions, and iodine uptake of the lesions are correlated with patient survival.

关 键 词：分化型甲状腺癌 -131Ⅰ治疗 放疗敏感性 

分 类 号：R736.1[医药卫生—肿瘤]