动态危险度评估在中高危无远处转移性分化型甲状腺癌患者随访中的意义  

Significance of Dynamic Risk Assessment in the Follow-up of Non-distant Metastatic Differentiated Thyroid Cancer Patients with Intermediate and High Risk

作　　者：刘杰蕊 刘延晴 李慧[2] 梁军[1] 林岩松[2] LIU Jierui;LIU Yanqing;LI Hui;LIANG Jun;LIN Yansong(Department of Oncology,the Affiliated Hospital of Qingdao University,Qingdao,Shandong 266003,China;Department of Nuclear Medicine,PUMC Hospital,CAMS and PUMC,Beijing 100730,China)

机构地区：[1]青岛大学附属医院肿瘤科,山东青岛266003 [2]中国医学科学院,北京协和医学院,北京协和医院核医学科,北京100730

出　　处：《中国医学科学院学报》2020年第2期222-227,共6页Acta Academiae Medicinae Sinicae

基　　金：国家自然科学基金(81771875);亚洲-太平洋甲状腺研究组项目。

摘　　要：目的动态评估中高危无远处转移性分化型甲状腺癌(DTC)患者复发风险的变化,为后续治疗及随访策略提供参考。方法纳入184例中高危无远处转移患者(中危111例、高危73例),根据动态危险度评估体系评估初始治疗后早期(6~12个月)的治疗疗效反应,将患者分为2组:早期疗效良好(ER)组(n=113)和早期疗效欠佳组(n=71),比较两组的一般临床病理特征;观察所有患者以及亚组分析中危和高危患者在初始治疗后早期和随访期末的动态危险度变化。结果与早期ER组患者相比,早期疗效欠佳组肿瘤直径较大(U=2771.500,P=0.000)、易于腺外侵犯(χ^2=4.070,P=0.044)以及131I治疗前刺激性甲状腺球蛋白水平更高(U=1367.500,P=0.000);早期疗效欠佳组患者中31%仅经过促甲状腺激素(TSH)抑制治疗,在随访期末转变为疗效良好[其中63.6%为中危患者尤以疗效不确切(IDR)患者居多,高危患者占36.4%];有6例(5.2%)早期ER患者在随访期末转变为IDR、血清学疗效欠佳甚至结构学疗效欠佳(1例中危患者经病理学证实颈部淋巴结复发),这些患者初始治疗后随访中TSH在0.56~10.35μIU/ml且未及时随诊纠正。结论部分早期评估未达ER的中高危无远处转移DTC患者,可能在后续TSH抑制治疗下逐渐转归达到ER,而TSH未规范抑制时可能使ER患者转变为疗效欠佳,实时动态危险度评估有助于及时了解疾病复发风险并调整后续的治疗及随访方案。Objective To tailor the subsequent treatment and follow-up strategy,this study dynamically assessed the response to initial therapy in non-distant metastatic differentiated thyroid cancer(DTC)patients with intermediate and high risk.Methods A total of 184 non-distant metastatic DTC patients(intermediate-risk 111 cases and high-risk 73 cases)were retrospectively enrolled in this study.Based on the results of initial response assessment(6-12 months after initial therapy),patients were divided into two groups:excellent response(ER)group(n=113)and non-excellent response(non-ER)group(n=71).We compared the differences in clinicopathological features between these 2 groups and evaluated the changes of dynamic response to therapy at the initial and final assessments after initial therapy in all patients.Results Compared with the ER group,the non-ER group showed a larger tumor size(U=2771.500,P=0.000),higher proportion of extrathyroidal invasion(χ^2=4.070,P=0.044),and higher preablative-stimulated thyroglobulin levels(U=1367.500,P=0.000).ER was achieved in 31%of patients in the initial non-ER group[including indeterminate response(IDR)and biochemical incomplete response(BIR)]at the final follow-up only by thyroid stimulating hormone(TSH)suppression therapy,among which 63.6%were with intermediate risk(especially the patients with IDR)and 36.4%at high risk.In addition,5.2%(6/113)of patients in the initial ER group were reassessed as IDR,BIR,or even structural incomplete response at the end of the follow-up(among which one patient developed into cervical lymph node recurrence,as confirmed by pathology);the TSH level in these patients fluctuated at 0.56-10.35μIU/ml and was not corrected in time during the follow-up after initial therapy.Conclusions Some of non-distant metastatic DTC patients with intermediate and high risks who presented initial non-ER may achieve ER only by TSH suppression therapy over time;in contrast,the patients presented initial ER may develop into non-ER without normalized TSH suppression therapy.The

关 键 词：分化型甲状腺癌 131I治疗 复发风险 甲状腺球蛋白 

分 类 号：R736.1[医药卫生—肿瘤]