中高危DTC患者术后较高剂量^(131)I治疗后疗效反应的影响因素分析  

Therapeutic response outcomes and influencing factors after surgery and a higher does of ^(131)I in patients with intermediate-to-high risk differentiated thyroid cancer

作　　者：张潇宇 阮卓 王秉攀 王宇 吴力翔[1] 刘建中[1] 武志芳[1] 陆克义[1] Zhang Xiaoyu;Ruan Zhuo;Wang Bingpan;Wang Yu;Wu Lixiang;Liu Jianzhong;Wu Zhifang;Lu Keyi(Department of Nuclear Medicine,First Hospital of Shanxi Medical University,Provincial and Ministerial Collaborative Innovation Center of Molecular Imaging Precision Diagnosis and Treatment,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一医院核医学科,分子影像精准诊疗省部共建协同创新中心,太原030001

出　　处：《国际放射医学核医学杂志》2022年第7期397-404,共8页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的探讨无转移的中高危分化型甲状腺癌(DTC)患者术后给予较高剂量^(131)I治疗的疗效及其影响因素。方法回顾性分析2018年1月至2020年12月于山西医科大学第一医院行DTC全切术后的378例中高危DTC患者的临床资料,其中男性103例、女性275例,中位年龄45(13~85)岁。所有患者均在术后给予首次^(131)I清甲和(或)辅助治疗,剂量3.70~5.55 GBq。同时^(131)I治疗前行术后残留甲状腺^(99)Tc^(m)O_(4)^(−)显像,治疗后2~7 d行^(131)I治疗后全身显像(Rx-WBS)。所有患者在^(131)I治疗后至少6个月进行随访,中位随访时间16.3个月。依据2015年美国甲状腺协会(ATA)指南的疗效反应评估体系进行术后^(131)I治疗疗效反应评估并分析影响因素。采用Spearman秩相关分析评估术后残留甲状腺^(99)Tc^(m)O_(4)^(−)显像靶/非靶比值(T/NT)与Rx-WBS评分的相关性;采用Mann-Whitney U检验、χ^(2)检验或Fisher确切概率法分析所有观察指标在疗效满意(ER)组与疗效欠佳(nER)组间的差异是否有统计学意义;采用Logistic回归分析影响预后ER的独立危险因素,并绘制ROC曲线,获得最佳诊断临界值。结果ER组与nER组间在肿瘤最大径、术后刺激性甲状腺球蛋白(psTg)水平、N分期、术后与首次^(131)I治疗间隔时间的差异均有统计学意义(Z=−7.127、−2.702,Fisher确切概率法,χ^(2)=6.783,均P<0.05);年龄、性别、被膜受累、肿瘤多灶性、T分期、复发风险分层、首次^(131)I治疗剂量、TSH水平、尿碘水平、甲状腺^(99)Tc^(m)O_(4)^(−)显像半定量指标T/NT、^(131)I Rx-WBS评分的差异均无统计学意义(Z=−1.505~−0.664,χ^(2)=0.064~5.501,Fisher确切概率法,均P>0.05)。Spearman秩相关检验分析结果显示,^(99)Tc^(m)O_(4)^(−)显像T/NT与Rx-WBS显像评分呈中度相关(r=0.530,P<0.001)。多因素Logistic回归分析结果显示,psTg水平是预后ER的独立危险因素。ROC曲线分析结果显示,psTg水平预测ER的最佳临界值为5.Objective To investigate the efficacy response and influencing factors of higher dose ^(131)I in patients with metastasis-free intermediate-to-high risk differentiated thyroid cancer(DTC).Methods The clinical date of 378 patients with intermediate-to-high risk DTC who attended in the First Hospital of Shanxi Medical University from January 2018 to December 2020 were retrospectively analyzed.The patients included 103 male and 275 female with a median age of 45(13-85)years.All patients were given the first ^(131)I remnant ablation and/or adjuvant therapy at a dose range of 3.70-5.55 GBq.Postoperative residual thyroid ^(99)Tc^(m)O_(4)^(−)image was performed before ^(131)I treatment,and ^(131)I post-treatment whole body scan(Rx-WBS)was performed 2-7 days after treatment.All patients were followed up at least 6 months with a median follow-up time of 16.3 months.The efficacy response evaluation system was evaluated according to the 2015 American Thyroid Association assessment system,and its influencing factors were analyzed.Spearman rank correlation analysis was used to evaluate the correlation between ^(99)Tc^(m)O_(4)^(−)image target/non-target(T/NT)ratio and Rx-WBS score.The Mann-Whitney U test,χ^(2) test or Fisher's exact probability method was utilized to analyze whether the difference between the excellent response(ER)and non-excellent response(nER)groups was statistically significant for all observed indicators.Binary multivariate Logistic regression was used to analyze the independent influencing factors of prognostic ER,receiver operator characteristic(ROC)curves were utilized to obtain optimal diagnostic thresholds.Results Stistically significant differences were observed in maximum tumor diameter,postoperative stimulated thyroglobulin(psTg)level,N stage,and interval time between the two groups of ER and nER(Z=−7.127,−2.702,Fisher's exact probability method,χ^(2)=6.783;all P<0.05).The differences were statistically insignificant for age,sex,capsule involvement,tumor multifocality,T-staging,risk of re

关 键 词：放射性核素治疗 碘放射性同位素 甲状腺球蛋白 分化型甲状腺癌 疗效 影响因素 

分 类 号：R736.1[医药卫生—肿瘤]