^131I治疗甲状腺乳头状癌颈部淋巴结转移的疗效观察及影响因素分析

The effectiveness and influencing factors of ^131I treatment for cervical lymph node metastases of papillary thyroid carcinoma

目的 探讨^131I治疗甲状腺乳头状癌（PTC）颈部淋巴结转移次数与疗效间的关系,并分析影响疗效的因素.方法 回顾性分析89例行^131I治疗的PTC术后患者（男24例,女65例,11-72岁）,所有患者清除甲状腺残留组织（简称清甲）或清除手术不能切除的PTC转移灶（简称清灶）治疗后全身及SPECT/CT显像提示单纯颈部淋巴结转移,且血清TgAb水平正常.记录每次治疗后患者显像结果、抑制（停药前）及激发（停药后）态Tg检测结果.综合B超、CT、^131I显像、Tg水平评价患者行第1-4次治疗后的效果,以CR及PR为^131I治疗有效.采用χ^2检验及logistic回归分析数据.结果 经1-4次治疗后患者有效率分别为57.30％ （51/89）、73.03％（65/89）、80.90％（72/89）和83.15％ （74/89）,差异有统计学意义（χ^2=18.792,P＜0.01）.Logistic回归分析显示,清甲治疗后131I显像颈部转移淋巴结是否显影及淋巴结大小是影响131I清灶治疗的因素.结论 ^131I是对PTC颈部淋巴结转移灶治疗的有效方法;一定范围内累计治疗有效率逐步增加.首次清甲治疗后显像转移淋巴结是否显影及淋巴结大小是影响疗效的重要因素.

Objective To evaluate the effectiveness and influencing factors of ^131I treatment for cervical lymph node metastases of papillary thyroid carcinoma （PTC）.Methods Eighty-nine post-operative PTC patients （24 males,65 females,11-72 years） with cervical lymph nodes as the only site of metastasis （negative serum TgAb,1-4 times of ^131I treatment） on 131I planar Rx-WBS or SPECT/CT were retrospectively reviewed.Results of 131I Rx-WBS or SPECT/CT,serum Tg levels under both TSH-suppressed and TSH-stimulated conditions were measured and recorded.CR and PR were recognized as effective therapy.χ^2 test and logistic regression analysis were used to analyze the data.Results The effective rate of 1-4 times of 131I treatment was 57.30%（51/89）,73.03%（65/89）,80.90%（72/89）,83.15%（74/89）,respectively （χ^2=18.792,P〈0.01）.Logistic regression analysis suggested that therapeutic effectiveness was related to the size of metastatic lymph nodes and whether metastatic lymph nodes could be visualized on the post-ablative ^131I Rx-WBS or SPECT/CT.Conclusions 131I treatment is an effective modality for PTC patients with cervical lymph nodes as the only site of metastasis.The cumulative effective rate increased within a limited times of treatment.The size of metastatic lymph nodes and whether metastatic lymph nodes could be visualized on the first post-ablative ^131I Rx-WBS or SPECT/CT are the key factors for the therapeutic effectiveness.