应用^(131)I化疗不同年龄背景下分化型甲状腺癌患者术后治疗疗效及预后评估

The Rapeutic Effect and Prognosis of Patients with Differentiated Thyroid Cancer under Different Age Backgrounds of ^(131)I Chemotherapy

目的通过分析术后^(131)I治疗对不同年龄背景下DTC患者的治疗疗效及预后,评估术后^(131)I治疗的价值。方法患者分为少年、青年、中年及老年组,甲状腺切除术后行^(131)I治疗,依据肺部CT扫描、血清TSH水平及Tg水平确定患者是否需要接受多次^(131)I治疗。分析患者二次治疗后的临床转归结果以及多次治疗成功后的生存率。结果少年及老年组患者淋巴结转移率、肺转移率及^(131)I二次治疗比例均高于中、青年组。临床转归情况、^(131)I二次治疗效果及平均治疗次数组间比较差异显著。肺转移患者治疗有效率与无肺转移患者相比差异显著。^(131)I多次治疗后复发率组间比较差异不显著,无进展累积生存差异不显著。结论相较于中、青年DTC患者,少年及老年患者更易发生淋巴结转移及肺转移,二次治疗临床转归效果也较低,复发率高。然而多次治疗至血清Tg水平转阴后的远期无进展生存情况无显著性差异。因此DTC术后^(131)I多次治疗对不同年龄背景的患者都是有效的治疗手段。

Objective To evaluate the therapeutic efficacy and prognosis of postoperative131I in patients with DTC under different age backgrounds and evaluate the value of postoperative131I treatment. Methods The patients were divided into adolescents,youth,middle-aged and elderly patients. The131I treatments were performed after thyroidectomy. According to the CT scan of the lungs,serum TSH levels and Tg levels,patients were treated with131I for several times. The clinical outcome after secondary treatment and the survival rate after multiple treatments were analyzed. Results The lymph node metastasis rate,pulmonary metastasis rate and the proportion of131I second treatment in adolescent and elderly patients were higher than those in middle and young patients. Clinical outcomes,131I secondary treatment and the average number of treatment was significantly different between the groups. There was a significant difference in the treatment response between patients with lung metastases and those without lung metastases. The recurrence rate of131I after multiple treatments was not significantly different between the two groups,and the cumulative progression-free survival was not significant. Conclusion Compared with young and middle-aged patients with DTC,juvenile and elderly patients are more prone to lymph node metastasis and lung metastases. The second treatment of clinical outcome is less effective and the higher recurrence rate. However,there was no significant difference in long-term progression-free survival after repeated treatment until serum Tg turned negative. Therefore,131I after DTC multiple treatment of patients of different age backgrounds are effective treatment.