分化型甲状腺癌远处转移发生放射性碘难治的危险因素及预测指标  

Risk factors and predictors of radioactive iodine refractory in differentiated thyroid cancer with distant metastasis

作　　者：单婵婵 仲爱生[1] 蔡刚明[2] 张健 Shan Chanchan;Zhong Aisheng;Cai Gangming;Zhang Jian(Department of Oncology,JiangYuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine,Wuxi 214063,China;Gene Laboratory,JiangYuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine,Wuxi 214063,China;Department of Orthopedics,Central Hospital Affiliated to Jiangnan University,Wuxi 214001,China)

机构地区：[1]江苏省原子医学研究所附属江原医院肿瘤科,无锡214063 [2]江苏省原子医学研究所附属江原医院基因实验室,无锡214063 [3]江南大学附属中心医院骨科,无锡214001

出　　处：《中华核医学与分子影像杂志》2024年第12期736-740,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨分化型甲状腺癌(DTC)远处转移发生放射性碘(RAI)难治(RAIR)的危险因素及预测指标。方法回顾性分析2007年1月至2023年11月在江苏省原子医学研究所附属江原医院接受^(131)I治疗的140例DTC远处转移患者[男51例、女89例,年龄51(14,82)岁]资料。根据^(131)I治疗效果,分为RAIR组(84例)和RAI治疗有效(RAIE)组(56例)。采用两独立样本t检验、Mann-Whitney U检验、χ^(2)检验比较2组患者的一般临床资料、B-Raf原癌基因丝/苏氨酸蛋白激酶(BRAF)V600E和端粒酶反转录酶启动子(TERTp)突变,采用多因素logistic回归分析RAIR的影响因素。结果RAIR组与RAIE组在年龄、年龄≥55岁、肿瘤最大径、RAI累积剂量、转移类型、术前甲状腺球蛋白(pre-Tg)差异均有统计学意义(χ^(2)值:7.78、9.03,t值:2.44~2.74,z=-3.92,均P<0.05)。RAIR组TERTp突变率为39.39%(26/66),明显高于RAIE组(2.17%,1/46;χ^(2)=20.97,P<0.001);RAIR组和RAIE组BRAF^(V600E)突变率为41.79%(28/67)和40.00%(20/50),差异无统计学意义(χ^(2)=0.04,P=0.846)。Logistic回归分析示pre-Tg高水平和TERTp突变是RAIR发生的独立危险因素。结论TERTp突变和pre-Tg高水平为RAIR发生的独立危险因素,二者可能成为具有潜力的预测RAIR的指标。ObjectiveTo investigate the risk factors and prognostic indicators of radioactive iodide refractory(RAIR)in differentiated thyroid cancer(DTC)with distant metastasis(DM).MethodsFrom January 2007 to November 2023,140 DM-DTC patients who received ^(131)I therapy in JiangYuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine were retrospectively conducted.According to the effect of ^(131)I treatment,84 cases in the RAIR group and 56 cases in the radioactive iodide efficient(RAIE)group were finally included.The general clinical data,B-Raf proto-oncogene,serine/threonine kinase(BRAF)V600E and telomerase reverse transcriptase promoter(TERTp)mutations were compared between the two groups by independent-sample t test,Mann-Whitney U test andχ^(2) test.Multiple logistic regression was used to analyze the influencing factors of RAIR.ResultsThere were significant differences between the RAIR group and the RAIE group in age,age≥55 years,tumor maximum diameter,cumulative dose of radioactive iodide,type of metastasis and preoperative thyroglobulin(pre-Tg)(χ^(2) values:7.78 and 9.03,t values:2.44-2.74,z=-3.92,all P<0.05).The TERTp mutation rate in RAIR group was 39.39%(26/66),which was significantly higher than that in RAIE group(2.17%(1/46);χ^(2)=20.97,P<0.001).The BRAF^(V600E) mutation rate was 41.79%(28/67)in the RAIR group and 40.00%(20/50)in the RAIE group,with no significant difference(χ^(2)=0.04,P=0.846).Logistic regression analysis found that high pre-Tg level and TERTp mutation were independent risk factors for RAIR occurrence.ConclusionTERTp mutation and high pre-Tg level are independent risk factors for RAIR occurrence,and they may be potential indicators for predicting RAIR.

关 键 词：甲状腺肿瘤 肿瘤转移 放射疗法 碘放射性同位素 危险因素 预测 

分 类 号：R736.1[医药卫生—肿瘤]