分化型甲状腺癌转移灶摄碘能力与131I清灶疗效关系的回顾性多中心研究

Correlation between 131I uptake and therapeutic efficacy in metastatic differentiated thyroid carcinoma: a retrospective multicenter study

目的探讨分化型甲状腺癌(DTC)转移灶摄碘能力与131I清除不能手术切除的DTC转移灶(简称清灶)疗效的关系。方法回顾性分析于31家单位核医学科行131I清灶治疗的138例DTC患者(男42例,女96例;年龄8~74岁)的临床资料。以清灶治疗时131I显像病灶靶/非靶(T/NT)比值代表其摄碘能力,以131I治疗前后病灶在影像上的径线变化评价该次疗效,分为完全缓解(CR)、部分缓解(PR)、稳定(SD)和进展(PD)。对可能影响131I清灶疗效的因素采用单因素分析(Kruskal-Wallis秩和检验,χ2检验和单因素方差分析)及二元logistic回归分析,建立病灶T/NT比值预测清灶无效的受试者工作特征(ROC)曲线。结果共统计1165次疗效评估。在653次平面显像评估中,CR、PR、SD和PD 4个疗效组间病灶T/NT比值差异无统计学意义(χ2=4.15,P>0.05);在512次断层显像评估中,有39次(7.6%)CR、337次(65.8%)PR、117次(22.9%)SD和19次(3.7%)PD,4组间病灶T/NT比值差异有统计学意义(χ2=30.46,P<0.01)。此外,年龄、刺激性甲状腺球蛋白(sTg)水平及服131I剂量也是影响131I清灶疗效的因素(F值或χ2值为2.561、7.095、8.799,均P<0.05)。Logistic回归分析显示患者确诊转移时的年龄越大[比值比(OR)=1.034,P=0.022]、病灶T/NT比值越低(OR=1.086,P=0.006),131I清灶疗效越差。病灶T/NT比值预测清灶无效的ROC曲线下面积为0.726,阈值为6.2,灵敏度、特异性分别为78.7%(107/136)、73.1%(275/376)。结论131I治疗DTC转移灶疗效显著,患者确诊转移时年龄、病灶T/NT比值是清灶无效的独立影响因素;病灶T/NT比值低于6.2时,预示131I清灶无效的概率较高。

Objective To investigate the correlation between 131I uptake and therapeutic efficacy in metastatic differentiated thyroid carcinoma(DTC).Methods The clinical data of 138 patients with metastatic DTC(42 males,96 females,age range:8-74 years)treated with 131I in nuclear medicine departments of 31 centers all over China were retrospectively analyzed.The lesional 131I uptake was quantitatively analyzed with target-to-nontarget(T/NT)ratio through the regions of interest in metastatic lesions confirmed by either planar or tomographic 131I SPECT/CT imaging.The efficacies of 131I treatment on the metastatic DTC were divided into complete remission(CR),partial remission(PR),stable disease(SD)and progress disease(PD)based on the change of the lesion diameter before and after the treatment.Factors which may affect therapeutic efficacy were assessed by the univariate(Kruskal-Wallis rank sum test,χ2 test and one-way analysis of variance)and binary logistic regression analyses.The receiver operating characteristic(ROC)curve of lesional T/NT ratio to predict the ineffectiveness of 131I therapy was performed.Results A total of 1165 efficacies were evaluated.The planar imaging results(n=653)showed that there was no statistically significant difference of T/NT ratio among CR,PR,SD and PD groups(χ2=4.15,P>0.05).The tomographic imaging results(n=512)suggested CR,PR,SD and PD in 7.6%(39/512),65.8%(337/512),22.9%(117/512),and 3.7%(19/512)of individuals,respectively,and the T/NT ratio among the four groups was significantly different(χ2=30.46,P<0.01).The univariate analysis also showed that age,stimulated thyroglobulin(sTg),131I dose were the factors affecting therapeutic efficacy(F orχ2 values:2.561,7.095 and 8.799,all P<0.05).Furthermore,binary logistic regression analysis revealed that older patients(odds ratio(OR)=1.034,P=0.022)or patients with lower lesional T/NT(OR=1.086,P=0.006)had a higher probability of ineffectiveness.The area under ROC curve for T/NT ratio to predict ineffectiveness was 0.726,and the cut-off value was 6.2,with a sensitivity of 78.7%(107/136)and a specificity of 73.1%(275/376).Conclusions 131I therapy is an effective treatment for metastatic DTC.The age at the time of metastatic diagnosis and the lesional T/NT ratio are independent influential factors for ineffectiveness of 131I therapy.When the leisonal T/NT ratio is lower than 6.2,the inefficiency of 131I is higher.