维甲酸诱导分化治疗甲状腺癌的临床研究

A clinical study of retinoid-induced differentiation therapy of advanced thyroid cancers

目的通过全反式维甲酸（ATRA）诱导分化治疗失分化甲状腺癌，并对其诱导分化的指标及疗效进行评价。方法15例失分化甲状腺癌，其中滤泡状癌5例，乳头状癌8例，滤泡乳头混合性癌2例。口服ATRA1～1．5mg·kg^-1·d^-1，持续治疗30d或60d，分别测定ATRA诱导分化治疗前后转移灶的摄碘变化、转移灶的大小及血清甲状腺球蛋白（Tg）水平，并进行比较。结果15例患者经ATRA诱导分化治疗，7例病灶的^131I摄取增高；7例转移灶缩小；12例测定Tg的患者中，同时具有Tg降低、病灶摄碘增高和病灶缩小或无变化的4例，占33％。结论ATRA对失分化甲状腺癌有一定疗效，并值得进一步研究。

Objective To evaluate the changes in differentiation markers and the therapeutic effects in all-trans-retinoic acid （ATRA） -treated patients with dedifferentiation thyroid cancers. Methods Fifteen patients with dedifferentiated thyroid cancer （DTC） （five follicular, eight papillary, two oxyphilic） were selected for treatment with ATRA 1～1.5 mg·kg^-1·d^-1 for 30 or 60 days. All patients had advanced tumor stages with prior operative and radioiedine treatment. Extensive tumor invasion and distant metastatic spread, and insufficient or devoid of radioiedine uptake precluded any conventional therapeutic option. Changes in ^131I uptake and size of metastatic focuses and serum thyroglobulin （Tg） level were measured and compared in these patients before and after ATRA therapy. Results In 15 patients with DTC after ATRA-induced differentiation therapy, iodine uptake was increased in 7 patients and the tumor size decreased in 7 patients; Tg was assessed in 12 patients, in whom 4 responders （33%） showed increased radioiodine uptake and decreased Tg level as well as decreased or stable tumor size. Conclusion ATRA does have an effect on dedifferentiation status of DTC and deserves further investigation.