影响分化型甲状腺癌^(131)I治疗获得最佳疗效反应的因素分析及治疗后的动态评估

Influencing factors to excellent response in differentiated thyroid cancer after ^(131)I therapy and ongoing assessment

目的:动态评估非远处转移分化型甲状腺癌(differentiated thyroid cancer,DTC)术后^(131)I治疗的疗效,分析影响患者达到最佳治疗反应(excellent response,ER)的因素。方法:回顾性分析2010年1月至2015年3月就诊于北京协和医院的非远处转移型DTC患者237例,观察治疗后2年内治疗反应,如最佳疗效反应(excellent response,ER)、疗效不确定(indeterminate response,IR)、生化改变(biochemical incomplete response,BIR)、结构性改变(structure incomplete response,SIR)的变化,对比分析不同复发危险分层及TNM分期患者治疗反应的差异,采用多因素分析探究影响ER的因素。结果:患者经^(131)I治疗后3个月及2年评估的ER、IR、BIR、SIR率分别为(3个月/2年):54.9%/73.0%、33.3%/18.1%、11.8%/6.0%、0/3.4%;3个月评估中IR者36例(45.6%)在2年时转为ER,BIR者8例(28.6%)发生病理组织学证实的颈部复发。复发危险分层与ER率呈负相关(r=0.973,P=0.147),TNM分期与治疗反应无明显相关性。影响ER的主要因素为肿瘤直径(P=0.008)、淋巴结转移数目(P=0.007)。结论:非转移DTC患者^(131)I治疗后ER率随时间呈升高趋势,近半数IR者将在治疗后2年内逐渐达到ER;病灶直径较小、淋巴结转移数目较少者更容易达到ER。

Objective： To continuously evaluate the response of differentiated thyroid cancer（DTC） after radioiodine therapy, and to analyze influencing factors for excellent response. Methods： Data of 237 patients with non-distant metastatic DTC treated in Peking Union Medical College Hospital were retrospectively analyzed, and the changes in response were evaluated（excellent response, ER;biochemical incomplete response, BIR; and structure incomplete response, SIR） 2 years after receiving the ^131I therapy. The responses of different recurrence-risk stratification and TNM stages were contrasted, and the influencing factors to ER were analyzed by multiplefactor analysis. Results： The percentage of the responses obtained 3 months and 2 years after ^131I therapy were（3 months/2 years） as follows： 54.9%/73.0%, 33.3%/18.1%, 11.8%/6.0%, and 0/3.4%. Of the initial IR patients, 45.6% were observed to transfer into ER and28.6% of the BIR patients are confirmed cervical recurrence by pathology. Recurrence-risk stratification and ER rate were negatively correlated（r=0.973, P=0.147）; however, TNM stage and response showed no evident correlation. The size of tumor and the number of lymph node metastasis were the main influencing factors in obtaining ER（P=0.008, 0.007, respectivtly）. Conclusion： The rate of ER in non-metastasis DTC patients increased gradually after receiving ^131I therapy. Approximately half of initial IR patients reached ER two years after treatment, and the patients with small diameter of tumor and less lymph node invasion tend to obtain ER.