分化型甲状腺癌术后131 I清灶疗效及影响因素分析

Efficacy and influential factors of post-resection 131 I therapy on metastases from differentiated thy- roid carcinoma

目的 探讨DTC术后131 I清除手术不能切除的DTC转移灶（简称清灶）的疗效及影响因素.方法 回顾性分析2012年1月至2016年10月于青岛大学附属医院行131 I清灶治疗的112例均伴转移的DTC患者[男41例,女71例;年龄8~80岁]的临床资料,对可能影响131 I清灶治疗的因素采用单因素分析（χ2检验、Mann-Whitney u检验和Kruskal-Wallis秩和检验）及二元logistic回归分析,对多因素分析提示有意义的指标建立其预测清灶无效的ROC曲线.结果 患者行131 I清灶治疗1~9次,总有效率为75.89%（85/112）;单因素分析显示原发癌灶直径、转移部位及首次清灶前sTg水平及sTg/TSH比值是清灶疗效的影响因素（χ2值：7.187,15.381;z值：-5.053,-5.187;均P＆lt;0.05）;logistic回归分析显示原发癌灶直径、首次清灶前sTg水平是影响DTC术后131 I清灶疗效的独立相关因素（均P〈0.05）.首次清灶治疗前sTg、sTg/TSH比值、原发癌灶直径预测清灶无效的ROC曲线下面积分别为0.824、0.832、0.718,阈值分别为29.825μg/L、0.298、3.250 cm,灵敏度分别为92.60%、96.30%、40.70%,特异性分别为62.40%、55.30%、91.80%.结论 131 I治疗DTC转移灶疗效显著.原发灶直径大、合并远处转移以及首次清灶前sTg水平高是清灶疗效的影响因素,也是预测131 I清灶疗效的重要指标.

Objective To investigate the efficacy and influential factors of post-resection 131 I thera-py in DTC patients with metastases can′t be removed by surgery. Methods A total of 112 DTC patients （ 41 males, 71 females, age range 8-80 years） with metastases from January 2012 to October 2016 in Affil-iated Hospital of Qingdao University were retrospectively analyzed. All patients underwent post-resection 131 I therapy, and the therapeutic effect was assessed. Univariate analysis （χ2 test, rank sum test） and the logis-tic regression analysis were performed to select the influential factors for treatment effect. The ROC curve a-nalysis of significant factors to predict the ineffectiveness of 131 I therapy was performed. Results Patients underwent single or repeated 131I therapy （1-9 times）, and the effective rate was 75.89%（85/112）. Univa-riate analysis showed that the tumor diameter, the location of metastasis, preablation sTg and sTg/TSH ratio were influential factors for 131 I therapy on metastases（χ2 values：7.187, 15.381;z values：-5.053,-5.187, all P〈0.05） . Logistic regression analysis showed that the tumor diameter, preablation sTg were independent influential factors for 131 I therapy （ both P〈0.05） . The areas under ROC curve for sTg, sTg/TSH ratio, and tumor diameter to predictive ineffectiveness were 0.824, 0.832, and 0.718, respectively. The cutoff values were 29.825μg/L, 0.298, 3.250 cm, respectively, the sensitivities were 92.60%, 96.30%, 40.70%, and the specificities were 62.40%, 55.30%, 91.80%. Conclusions The therapeutic effect of 131I therapy on metastases from DTC is significant. The longer tumor diameter, the distant metastasis, and the higher preab-lation sTg are negative influential factors for131 I therapy, which could be used to predict the therapeutic effect.