甲状腺癌转移灶失分化影响因素分析

Influencing Factor of Metastases of Differentiated Thyroid Cancer Developing Into Non-iodine-avid Lesions

目的:分化型甲状腺癌(DTC)转移灶失分化的患者预后较差。本文研究DTC转移灶的影响因素。方法:回顾性分析在我科行131I治疗有转移的DTC患者121例。转移灶通过18F-FDG肿瘤显像、131I-SPECT/CT、CT、MRI、B超等影像学手段结合血清HTg诊断,部分通过手术病理证实。转移灶摄碘情况通过大剂量131I治疗后全身显像上观察。根据转移灶摄碘情况将患者分为摄碘组和不摄碘组(失分化组),分析相关影响因素。结果:51例(42.1%)患者转移灶不摄碘。单因素分析提示,淋巴结转移灶较远处转移更容易发生失分化(χ2=4.338,P<0.05),而肺转移和骨转移之间无明显差异(χ2=1.509,P>0.05)。双变量logistic回归模型提示导致转移灶不摄碘的危险因素有:乳头状癌(OR=0.059;95%CI 0.010,0.037;P<0.01)、年龄(OR=1.050;95%CI 1.019,1.082;P<0.01)、转移发生时间(OR=4.122;95%CI 1.421,11.894;P=0.000)和复发(OR=4.299;95%CI 2.132,7.685,P=0.000)。结论:DTC患者中淋巴结转移灶较远处更容易发生失分化不摄碘,但是远处转移中肺转移和骨转移发生失分化的几率无明显差异。年龄、乳头状癌、转移发生时间和复发是影响失分化的危险因素。

Objective Differentiated thyroid cancer（DTC） patients with non-iodine-avid metastases have a poor prognosis.The present study was conducted to evaluate the influencing factors of radioiodine uptake in metastases of DTC patients.Methods DTC patients（n=121） with metastases treated with 131I were retrospectively included.Metastases were diagnosed by 18F-fluorodeoxyglucose positron emission tomography,CT,MRI or surgery.Iodine avidity was determined by visual uptake at the metastatic site using a post-therapeutic 131I whole body scan.Patients with metastases were classified into iodine-avid and non-iodine-avid subgroups and their clinical features were retrospectively evaluated.Results 51 patients had non-iodine-avid metastases（42.1%）.A univariate analysis showed that lymph node metastases became non-iodine-avid more frequently than distant metastases（χ2 = 4.338,P0.05）.A binary variable logistic regression model revealed four significant predictors of non-iodine-avid metastasis occurrence： papillary carcinoma（OR=0.059;95% CI 0.010,0.037;P〈0.01）,age（OR=1.050;95% CI 1.019,1.082;P〈0.01）,time of metastasis development（OR=4.122;95% CI 1.421,11.894;P=0.000）,and recurrence（OR=4.299;95% CI 2.132,7.685,P=0.000）.Conclusion The lymph node metastases in DTC patients lost the ability to concentrate iodine more frequently than distant metastases,but bone and lung metastases showed an equivalent rate of becoming non-iodine-avid lesions.Age,papillary carcinoma,time of metastasis development,and recurrence were identified as risky factors of non-iodine-avid metastases.