放射性^(131)Ⅰ去除分化型甲状腺癌术后残留甲状腺组织的疗效与影响因素分析

Efficacy and influencing factors of radioactive ^(131)Ⅰ for elimination of thyroid remnants following differentiated thyroid carcinoma resection

目的研究应用放射性131Ⅰ首次去除分化型甲状腺癌(DTC)术后残留甲状腺组织的疗效及其影响因素。方法 DTC患者51例,其中,甲状腺乳头状癌48例,滤泡状癌3例。所有DTC患者均行外科手术治疗,并于术后平均15个月内给予131I治疗,剂量为(2.96～5.55)GBq(80～150mCi),131Ⅰ治疗后平均6个月行第2次大剂量131Ⅰ治疗,并于7d后行131Ⅰ全身显像,甲状腺部位无残留甲状腺组织显影被认为首次"清甲"成功。影响因素采用t检验、χ2检验进行单因素分析、binary Logistic回归方法进行多因素分析。结果 51例DTC患者,首次"清甲"成功者22例(占43%)、未成功者29例(占57%)。残留甲状腺组织的大小(χ2=4.965,P=0.026)、首次手术距"清甲"治疗的时间(Z=-2.631,P=0.009)、"清甲"前血清促甲状腺激素(TSH)水平(Z=-2.149,P=0.032)、"清甲"前血清甲状腺球蛋白(Tg)水平(Z=-2.815,P=0.005)及"清甲"前有无转移(χ2=12.466,P=0.002)是"清甲"成功与否的影响因素。Binary Logistic回归分析结果表明,"清甲"前血清TSH(Wald=4.209,P=0.040)及Tg水平(Wald=4.563,P=0.033)是"清甲"成功与否的影响因素。结论 131Ⅰ首次去除DTC术后残留甲状腺组织患者术后残留甲状腺组织少、首次手术距"清甲"治疗间隔时间短、TSH水平高、Tg水平低及无甲状腺外转移者,其"清甲"成功率较高。其中,"清甲"前血清TSH及Tg水平是影响首次"清甲"成功率的最重要因素。

Objective To investigate the efficacy and influencing factors of radioactive 131I on residual thyroid tissues following differentiated thyroid carcinoma （DTC） resection. Methods A total of 51 patients with DTC, including 48 with papillary thyroid carcinoma and 3 with follicular thyroid carcinoma, were recruited in the study. All patients underwent 131I radiotherapy [（2.96-5.55） GBq] following a mean of 15.2 months postoperatively. Subsequent high-dose 13q radiotherapy was performed at month 6. This entailed3＇I systemic imaging at day 7 thereafter. Initial thyroid ablation was regarded as successful provided that residual thyroid gland was absent on mI systemic imaging. Univariate analysis using t-test and X2 test, and multivariate analysis using binary Logistic model were conducted. Results Of 51 patients enrolled in the study, 22 （43%） achieved initial thyroid remnant ablation and 29 （57%） failed. Univariate analysis suggested that the thyroid residual volume （X2=4.965, P=0.026）, the interval from initial re- section to initial 13~I ablation （Z=-2.631, P=0.009）, serum TSH （Z--2.149, P=0.032）, serum Tg （Z=-2.815, P=0.005） and presence of metastasis （X2=12.466, P=0.002） prior to 3I ablation therapy were the influencing factors reflecting outcomes of mI ablation. Binany loqistic regression analysis showed that serum TSH （Wald--4.209, P=-0.040）, serum Tg （Wald=4.563, P=0.033） were influencing factors of 3I ablation therapy. Conclusion Initial ablation of thyroid rem- nant using mI radiotherapy yields a successful rate of 43%. Patients with DTC showing reduced thyroid residual vol- ume, shortened interval from initial resection surgery to initial mI ablation, higher serum TSH, lower serum Tg, absence of extrathyroidal metastasis are associated with a higher success rate of 13I radiotherapy. Among them, the serum TSH and T are the most important factors of the success of ＇hi radiotherapy for elimination of thyroid remnants.