对甲状腺乳头状癌术后残留患者行核素治疗效果的评价及再次手术治疗的作用

Evaluation of radionuclide therapy for the residue after surgery in papillary thyroid carcinoma

目的观察核素治疗对甲状腺乳头状癌术后残留患者的疗效评价及再手术的作用。方法选择20例首诊在外院治疗后有甲状腺乳头状癌残留，并曾接受核素治疗的患者进行分析。其中I期13例，Ⅲ期3例，Ⅳ期d例。因颈部仍有肿瘤残留在中国医学科学院肿瘤医院行再次手术，再手术时切除残留甲状腺肿瘤5例，颈淋巴清扫15例（20侧）。同时对比20例患者在外院行核素治疗前后CT影像学上的肿瘤变化，采用实体瘤疗效评价标准（Response Evaluation Criteriain Solid Tumors，RECIST）评价其客观疗效。数据采用SPSSl7．0进行统计学分析。结果20例患者年龄22～58岁，中位年龄40岁；核素治疗前接受过1～4次手术，平均1．5次；行核素治疗2-6次，平均3．3次，剂量210-660mCi，平均318mCi。对20例曾行手术及核素治疗患者的CT影像学资料进行评价，结果显示行核素治疗前后患者的靶病灶变化差异无统计学意义（t=1．177，P〉0．05）。再次手术后经病理证实均有肿瘤残留或颈淋巴结转移。结论对甲状腺乳头状癌术后残留或转移患者，再次手术应为优先选择，核素治疗无明显治疗作用，应仅选择性用于有远处转移，或其他原因不能手术者，以及具备摄碘功能，颈部病灶得以彻底切除后病例的辅助治疗。

Objective To assess the efficacy of radioactive iodine （RAI） for the treatment of residual papillary thyroid cancer （PTC） after surgery. Methods A total of 20 patients diagnosed with PTC and underwent 2 -6 courses of RAI therapy for residual PTC after surgery in other hospitals were included our study. Of these, 13 were in stage Ⅰ ,3 in stage Ⅲ and 4 in stage 1V. All the cases were operated again due to the presence of suspicious residual tumors indicated by CT. Excision of thyroid tumor residue was performed in 5 cases and neck dissection in 15 cases （20 sides）. The suspicious thyroid or neck residual tumors were examined pathologically after surgery. Response Evaluation Criteria in Solid Tumors（RECIST） was used to evaluate the efficacy of surgery treatment on residual tumor. T-test was used to identify variables associated to RAI and to calculate the propensity score to receive RAI after surgery. Results The patients aged 22 -58 years, with a median age of 40 years. The mean times of surgeries received before RAI was 1.5 and the mean dose of applied RAI was 318 mCi（210 -660 mCi）. No significant difference in tumor size between pre-RAI and post-RAI was found （ t = 1. 177, P 〉 0. 05 ）. With postoperative pathological examination, the suspicious thyroid or neck residual tumors were confirmed as PTC or the cervical lymph metastasis of PTC. Conclusions For the residue or metastasis of PTC after operation, reoperation should be a priority, while RAI therapy has no obvious therapeutic effect and it should be limited to selected cases such as those with distant metastasis or unsuitable for operation but with iodine uptake function, or taken as an adjuvant treatment after radical resection of cervical lesions.