| 季艳会,王萱,李雪,等.家族性与散发性分化型甲状腺癌患者131I治疗反应与临床转归的比较[J].中华放射医学与防护杂志,2024,44(6):531-536.Ji Yanhui,Wang Xuan,Li Xue,et al.Comparison of 131I therapeutic responses and clinical outcomes in patients with familial and sporadic differentiated thyroid cancer[J].Chin J Radiol Med Prot,2024,44(6):531-536 |
| 家族性与散发性分化型甲状腺癌患者131I治疗反应与临床转归的比较 |
| Comparison of 131I therapeutic responses and clinical outcomes in patients with familial and sporadic differentiated thyroid cancer |
| 投稿时间：2023-11-27 |
| DOI：10.3760/cma.j.cn112271-20231127-00188 |
| 中文关键词: 家族性甲状腺癌 治疗反应 131I治疗 疾病状态 |
| 英文关键词:Familial differentiated thyroid carcinoma Therapeutic response 131I therapy Disease state |
| 基金项目:天津医科大学总医院新世纪人才项目(2090602405);天津市卫生健康科技项目(ZC20181) |
| 作者 | 单位 | E-mail | | 季艳会 | 天津医科大学总医院核医学科, 天津 300052 | | | 王萱 | 天津医科大学总医院核医学科, 天津 300052 | | | 李雪 | 天津医科大学总医院核医学科, 天津 300052 | | | 孙丹阳 | 天津医科大学总医院核医学科, 天津 300052 | | | 肖茜 | 天津医科大学总医院核医学科, 天津 300052 | | | 何雅静 | 天津医科大学总医院核医学科, 天津 300052 | | | 孟召伟 | 天津医科大学总医院核医学科, 天津 300052 | | | 贾强 | 天津医科大学总医院核医学科, 天津 300052 | | | 谭建 | 天津医科大学总医院核医学科, 天津 300052 | | | 郑薇 | 天津医科大学总医院核医学科, 天津 300052 | zhengw@tmu.edu.cn |
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| 中文摘要: |
| 目的 分析不同家族性分化型甲状腺癌(FDTC)与散发性分化型甲状腺癌(SDTC)患者首次131I治疗(RIT)反应的临床转归及影响因素。方法 对2016年1月至2022年1月间于天津医科大学总医院接受RIT的120例FDTC与480例SDTC患者进行回顾性分析。分析两组患者首次RIT不同疗效反应,分析无病(NED)亚组的无病生存期(DFS)、生化疾病持续(BPD)及结构或功能性疾病持续(S/FPD)亚组的无进展生存期(PFS),并筛选未达到NED状态的危险因素。结果 首次RIT后FDTC及SDTC组达到NED、BPD及S/FPD状态的患者分别为56(46.7%)、50(41.7%)、14(11.6%)及284(59.1%)、160(33.3%)、36(7.5%)例(χ2=10.10,P=0.013)。末次随访时,FDTC及SDTC组达到NED、BPD及S/FPD状态的患者分别为71(59.1%)、36(30.1%)、13(10.8%)及337(70.2%)、114(23.7%)、29(6.1%)例(χ2=8.99,P=0.026)。家族性(F)-NED及散发性(S)-NED亚组患者5年DFS率分别为92.4%及97.4%;F-BPD及S-BPD亚组5年PFS率分别为88.3%及90.8%;F-S/FPD及S-S/FPD亚组5年PFS率分别为78.2%及79.6%。采用二元logistic单因素分析显示肿瘤最大径、T分期、M分期、复发危险度分层、术后刺激状态甲状腺球蛋白(p-sTg)与患者否达到NED状态相关(χ2=6.37~13.10,P＜0.05);采用二元logistic多因素回归分析显示T分期、p-sTg是能否达到NED状态的独立危险因素(χ2=0.11~11.33,P＜0.05)。结论 初始RIT治疗反应有助于指导后续治疗和随访策略,SDTC患者临床转归优于FDTC患者,应提高FDTC患者前站RIT警惕性,对于p-sTg及T分期较高患者,应酌情增加首次RIT剂量、缩短随访间隔。 |
| 英文摘要: |
| Objective To analyze the clinical outcomes of initial radioactive iodine 131I therapy (RIT) for patients with familial differentiated thyroid cancer (FDTC) and sporadic differentiated thyroid cancer (SDTC), along with their influencing factors. Methods The clinical data of 120 FDTC and 480 SDTC patients who received RIT at the Department of Nuclear Medicine, Tianjin Medical University General Hospital from January 2016 to January 2022 were retrospectively analyzed. These patients, categorized into the FDTC and SDTC groups, were further divided into three subgroups based on their response to initial RIT: no evidence of disease (NED), biochemical persistence of disease (BPD), or structural/functional persistence of disease (S/FPD). For the NED subgroup, the disease-free survival (DFS) was analyzed. For the BPD and S/FPD subgroups, the progression-free survival (PFS) was investigated. Furthermore, risk factors for failure to reach the NED status were identified. Results After initial RIT, 56 (46. 7%), 50 (41. 7%), 14 (11. 6%) patients in the FDTC group reached the NED, BPD, and S/FPD statuses, respectively, while 284 (59. 1%), 160 (33. 3%), 36 (7. 5%) and SDTC patients in the SDTC group were in the NED, BPD, and S/FPD statuses, respectively (χ2 = 10. 10, P = 0. 013). The last follow-up revealed that 71 (59. 1%), 36 (30. 1%), 13 (10. 8%) patients in the FDTC group were in the NED, BPD and S/FPD statuses, respectively, while 337 (70. 2%), 114 (23. 7%), 29 (6. 1%) patients in the SDTC group reached the NED, BPD and S/FPD statuses, respectively (χ2 = 8. 99, P = 0. 026). The F-NED and S-NED subgroups exhibited 5-year DFS rates of 92. 4% and 97. 4%, respectively, the F-BPD and S-BPD subgroups displayed 5-year PFS rates of 88. 3% and 90. 8%, respectively, while the F-S/FPD and S-S/FPD subgroups yielded in 5-year PFS rates of 78. 2% and 79. 6%, respectively. Univariate binary logistic regression analysis indicated that the maximum diameter of tumors, T stage, M stage, recurrence risk stratification, and postoperative stimulated thyroglobulin (p-sTg) were correlated with the achievement of the NED status (χ2=6. 37-13. 10, P＜0. 05). Multivariable binary logistic regression analysis showed that T stage and p-sTg were independent risk factors in the achievement of the NED status (χ2=0. 11-11. 33, P＜0. 05). Conclusions The response to initial RIT assists in guiding the development of subsequent treatment and follow-up strategies for DTC patients. Given that the SDTC patients exhibited better outcomes than the FDTC patients, more alertness should be paid to the RIT for FDTC patients. For patients with higher p-sTg and T stage, the initial RIT dose and follow-up interval should be increased and reduced respectively as appropriate. |
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