^(131)I治疗分化型甲状腺癌伴肺转移的疗效及影响因素分析

Analysis of the efficacy and influence factors of ^(131)I therapy for lung metastases of differentiated thyroid carcinoma

目的分析^(131)I治疗分化型甲状腺癌(DTC)伴肺转移的疗效、影响因素以及不良反应。方法回顾性分析49例接受^(131)I治疗的DTC伴肺转移患者。影响因素包括年龄、性别、累积剂量、病理学类型、显像时机、摄^(131)I形态、治疗前Tg水平、颈部淋巴结转移等。统计学方法包括t检验、χ~2检验及Logistic回归分析。同时,观察^(131)I治疗和随访期间的不良反应。结果^(131)I治疗DTC伴肺转移的有效率为63.3%(31/49),无效率为36.7%(18/49)。单因素分析显示:年龄(t=4.194,P<0.001),治疗前Tg水平(t=3.632,P<0.05),胸片和(或)CT显示(χ~2=7.385,P<0.05),伴其他远处转移(χ~2=8.586,P<0.05)及显像时机(χ~2=8.077,P<0.05)5个因素与^(131)I疗效有关;Logistic回归分析显示:年龄、伴其他远处转移及治疗前Tg水平是^(131)I治疗DTC伴肺转移疗效的独立影响因素。^(131)I治疗对患者造血功能、肝功能等无明显影响,仅有少部分患者会出现唾液腺功能受损。结论^(131)I是治疗DTC伴肺转移的有效手段,不良反应少,其中年龄小、治疗前Tg水平低以及仅肺转移的患者^(131)I疗效好。

Abstract Objective To analyze the efficacy, influence factors and side effects of 131I therapy for lung metastases of differentiated thyroid carcinoma （ DTC ）. Methods 49 patients with lung metastases of DTC who received 131I treatment were retrospectively analyzed. Influence factors included patients＇age, gender, cumulative doses, patho- logical classification, times of lung metastases by 131I imaging, 131I uptake pattern, Tg levels before treatment, cer- vical lymph node metastases and so on. Statistical methods included t test, χ2 test and Logistic regression analysis. Meantime, the side effects were observed during the 131I treatment and follow-up period. Results The rates of partial response and invalidity of 131I treatment DTC with lung metastases were 63.3% （31/49） and 36.7% （18/49） respectively. Univariate analysis showed that ： age（t = 4. 194, P 〈 0. 001 ）, Tg levels before treatment（ t = 3. 632, P 〈 0. 05）, Chest X-ray and（or） CT finding（ χ2 = 7. 385, P 〈 0. 05 ）, other distant metastases（ χ2 = 8. 586, P 〈 0. 05 ）, times of lung metastases by 131I imaging（ χ2 = 8. 077 ,P 〈 0.05） were the factors influencing outcome of 131I treatment. Logistic regression analysis showed that the influence factors included age, Tg levels before treatment and other distant metastases. 131I treatment had no significant effect on hematopoietic function and liver function, but salivary gland function of some patients was impaired. Conclusion 131I therapy is effective and safe for lung metastases of DTC, and the younger, the significant decrease of Tg levels before treatment and only lung metastases indicate a well prognosis.