中、低危分化型甲状腺癌术后碘(131I)治疗对短期临床转归的影响  

Analysis of short-term outcome in low-to-intermediate-risk thyroid cancer patients after post-operative iodine-131(131I) treatment

作　　者：白熠洲 郭佳宜 刘安阳[1] 罗斌[1] BAI Yi-zhou;GUO Jia-yi;LIU An-yang;LUO Bin(Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院/清华大学临床医学院普通外科

出　　处：《中国医刊》2019年第11期1201-1205,共5页Chinese Journal of Medicine

基　　金：北京清华长庚医院青年启动基金（12017C1024）;北京市卫生系统高层次卫生技术人才项目（2013-2-032）

摘　　要：目的分析中、低危分化型甲状腺癌行甲状腺全切除术后接受放射性碘(131I)治疗对短期临床转归的影响。方法选取2015年1月至2018年12月在清华大学附属北京清华长庚医院/清华大学临床医学院行甲状腺全切除术且术后静态评估为中、低危的分化型甲状腺癌患者92例,按术后是否接受放射性131I治疗分为接受131I治疗组和未接受131I治疗组,其中接受131I治疗组29例,未接受131I治疗组63例。动态随访至少2次,包括术后早期(基线)随访1次,临近研究截止时(2019年2月)再随访1次。根据2次随访时的血清甲状腺球蛋白水平及影像学等资料进行治疗效果评价和动态复发风险评估。结果中位随访时间为12(2~48)个月。基线随访时接受131I治疗组病情较重,两组间静态复发风险、肿瘤大小及淋巴结转移数有显著差异(P<0.05)。经过治疗后,近期随访时的接受和未接受131I治疗组完全缓解率分别为69.0%(20/29)、76.2%(48/63),组间差异无显著性(P=0.463)。近期随访时的动态复发风险分层评估显示,两组的良好反应率、不确定反应率、生化不完全反应率和结构不完全反应率差异无显著性(P=0.160)。基线状态下未达到良好反应的患者接受131I治疗后,其动态复发风险评估获得的改善较未接受131I治疗者明显提升(P=0.004)。在接受131I治疗组内,与治疗前相比,131I治疗后完全缓解率显著升高(P=0.004),动态风险分层显著降低(P=0.015),血清甲状腺球蛋白水平显著降低(P=0.001)。92例患者在甲状腺全切除术后,基线状态下即达到完全缓解的比例为56.5%(52/92),且肿瘤较小或转移淋巴结数目较少的亚组完全缓解率较高。结论甲状腺全切除术后静态评估为中、低危的分化型甲状腺癌患者中,符合131I治疗适应证者虽然其基线状态下病情较重,但接受131I治疗后其短期临床转归与未接受131I治疗的患者趋于一致。肿瘤大小及转移淋巴结�Objective Analyze the impact of radioactive iodine-131(131I)treatment after total thyroidectomy on therapeutic effect evaluation and dynamic recurrence risk stratified assessment,and explore the effect of different treatment strategies on short-term clinical outcomes of low-intermediate risk thyroid cancer patients.Method 92 patients with low-to-intermediate-risk differentiated thyroid cancer who underwent total thyroidectomy between January 2015 and December 2018 in the General Surgery Department of Beijing Tsinghua Changgeng Hospital are selected as the sample of this search.The patients were divided into two groups:those who received or did not receive radioactive 131I ablation.Those patients were followed up dynamically,with one early follow-up after operation(baseline follow up)and another follow-up when this study nearly finished(most recent follow up)until February 2019.Then we carried out the dynamic recurrence risk assessment and therapeutic effect evaluation base on patients’serum thyroglobulin level and imaging data during the two follow-up periods.Mann-Whitney U Rank Sum Test andχ2 test were used for data analysis and comparison.Result The median follow-up length was 12(2-48)m.Data from baseline follow up suggest that the 131I treatment group was in more serious conditions than the non-131I treatment group.There are significant differences between the two groups on static recurrence risk,tumor size and lymph node metastasis.After the treatment,at the most recent follow up,the complete remission rate was 69.0%(20/29)in the 131I treatment group and 76.2%(48/63)in non-131I treatment group.Differences between these two groups are not statistically significant(P=0.463).Also,there are no significant differences between the two groups in their four categories(i.e Excellent Response,Indeterminate response,Biochemical incomplete response and Structural incomplete response)of stratified risk assessment of dynamic recurrence(P=0.160).Among all the patients who did not have an excellent response at the baselin

关 键 词：分化型甲状腺癌 甲状腺全切除术 放射性131I治疗 甲状腺球蛋白 动态复发风险分层 

分 类 号：R736.1[医药卫生—肿瘤]