^131I治疗分化型甲状腺癌骨转移的疗效评价和生存分析

Evaluation of ^131 I treatment efficacy and prognostication for bone metastases from differentiated thyroid cancer

目的评价^131I治疗DTC骨转移的疗效及影响因素，评估生存率及其影响因素。方法回顾分析经^131I治疗的106例DTC骨转移患者的临床资料，分别基于^131I治疗后血清Tg的变化、骨痛缓解情况和影像学变化评价^131I治疗疗效，并对影响^131I疗效的因素进行单因素分析；采用寿命表法评估DTC骨转移患者的^131I治疗后总生存率；采用Kaplan—Meier法对影响生存率的因素进行分析，应用Log-rank法比较各组间差异。结果经^131I治疗后血Tg显著下降者37例，有效率34．9％。骨转移伴疼痛的61例DTC经^131I治疗后疼痛明显缓解者39例，有效率63．9％。患者年龄、病理类型、是否合并其他非骨性远端转移等因素对^131I治疗后血Tg的变化有影响（x2=6．443，11．455和6．756，P均〈0．05），但对^131I治疗后骨痛缓解的影响无统计学意义（x2=0，0，0．060，P均〉0．05）。^131I治疗后77．4％的患者骨转移灶无明显影像学变化。该组DTC骨转移患者5年和10年生存率分别为86．47％和57．90％；骨转移灶数目、是否合并其他远端脏器转移、^131I治疗前是否行手术治疗对患者的10年生存率影响差异有统计学意义（Log-rank值为4．05，5．98和4．22，P均〈0．05）；患者的性别、年龄、病理类型、是否以骨转移症状首诊等因素对10年生存率无明显影响（Log—rank值为0．01，1．56，2．59和0．04，P均〉0．05）。结论^131I治疗可使DTC骨转移患者血清Tg下降、骨痛缓解、病灶保持稳定或缩小，是治疗DTC骨转移的有效手段；单发病灶、单纯骨转移、手术＋^131I治疗患者预后较好。

Objective To evaluate the efficacy of ^131 I treatment for bone metastases from DTC and analyze the survival rates after ^131I treatment and prognostic factors. Methods One hundred and six DTC patients with bone metastases treated by ^131I during January 1991 and January 2009 were retrospectively analyzed. Treatment efficacy was assessed based on serum Tg change, bone pain palliation and changes on medical imaging. Univariate analysis was performed for defining the factors affecting ^131I treatment efficacy. Survival curves were estimated using the life table method. Survival analysis was performed using Kaplan- Meier method. Results Serum Tg decreased dramatically in 37/106 （ 34.9% ） patients treated withTM I. Thirty-nine of 61 patients （63.9%） with bone pain had pain relief. Age, tumor subtype and presence of non-osseous distant metastases were significant factors affecting ^131I treatment efficacy based on serum Tg change （ X2 = 6. 443, 11. 455, 6. 756, all P 〈 0. 05 ）, but had no significant effects on bone pain palliation （ X2 = 0, 0, 0. 060, all P 〉 0.05 ）. There were no imaging changes of bone metastases in 77.4% of patients after ^131I treatment. The overall 5-year and 10-year survival rates from initial diagnosis of bone metastases was 86.47% and 57.90% , respectively. Univariate analysis showed that number of metastases, presence of non-osseous distant metastases and pre-^131 I treatment surgery were significant factors for survival （ Log-rank values were 4.05, 5.98, 4.22, all P 〈 0.05 ）. Conclusions ^131 I treatment for bone metastases from DTC is effective for lowering serum Tg and palliation of bone pain. Single metastasis, absence of nonosseous distant metastases and pre-^131I therapy surgery are favorable predictors of prognosis.