分化型甲状腺癌骨转移的预后及影响因素  

Outcomes and prognostic factors of differentiated thyroid cancer with bone metastasis

作　　者：王燕 郑容 樊蓉 林琳 耿建华 WANG Yan;ZHENG Rong;FAN Rong;LIN Lin;GENG Jianhua(Department of Nuclear Medicine,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021 China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院核医学科,北京100021

出　　处：《中国辐射卫生》2023年第1期46-51,61,共7页Chinese Journal of Radiological Health

基　　金：中国癌症基金会“北京希望马拉松”专项基金(LC2020A04)。

摘　　要：目的 探讨分化型甲状腺癌(differentiated thyroid cancer,DTC)骨转移患者的预后及影响因素。方法 回顾性分析108例DTC骨转移患者,所有患者均在中国医学科学院肿瘤医院接受DTC骨转移治疗。应用Kaplan-Meier生存分析构建生存曲线,通过log-rank检验及构建Cox比例风险模型筛选影响预后因素,着重分析治疗方式与预后的相关性。结果 108例患者中位生存时间为70个月,5、10、15、20年总体生存率分别为54.4%、24.3%、9.8%、4.3%。单因素分析结果显示,单一骨转移灶、不发生临床骨相关事件(skeletal-related events,SREs)及颈部淋巴结转移的患者预后较好(P=0.003~0.019)。接受联合治疗(P <0.001)及只接受^(131)I治疗的患者(P=0.109),预后均好于接受了非^(131)I的治疗患者。多因素变量分析结果显示,只有单一骨转移灶、SREs、治疗方式是独立预后因素。结论 对于DTC骨转移的患者,仅有单一骨转移,没有发生SREs以及采用^(131)I治疗联合多种治疗手段与良好预后显著相关。Objective To investigate the outcomes and prognostic factors of differentiated thyroid cancer(DTC) with bone metastasis.Methods A retrospective study was conducted on 108 DTC patients with bone metastasis who were treated in the Cancer Hospital of Chinese Academy of Medical Sciences.Kaplan-Meier survival curves were generated.Log-rank test and Cox proportional hazards model were used to screen the prognostic factors.The correlation between treatment and prognosis was analyzed.Results The median overall survival was 70 months.The 5-,10-,15-,and 20-year overall survival rates were 54.4%,24.3%,9.8%,and 4.3%,respectively.Univariate analysis showed improved prognosis in patients with single bone metastasis,without skeletal-relatedevents(SREs),and without cervical lymph node metastasis(P = 0.003-0.019).Patients who received combined treatments(P<0.001) or ^(131)I treatment alone(P = 0.109) showed better prognosis than those without ^(131)I treatment.Multivariate analysis identified single bone metastases,SREs,and treatmentas independent prognostic factors.Conclusion In DTC patients with bone metastasis,good prognosis is significantly associated with single bone metastases,absence of SREs,and ^(131)I therapy in combination with other therapeutic approaches.

关 键 词：分化型甲状腺癌 骨转移 碘131(^(131)I) 预后 影响因素 

分 类 号：R815[医药卫生—放射医学]