中高危甲状腺乳头状癌患者^(131)I治疗后临床转归的影响因素

Factors Influencing Clinical Turnover After ^(131)I Treatment in Patients with Medium-and High-risk Papillary Thyroid Cancer

目的探讨中高危甲状腺乳头状癌(PTC)患者^(131)I治疗后临床转归的影响因素。方法回顾性分析接受^(131)I治疗的112例中高危PTC患者临床资料,分析中高危PTC患者^(131)I治疗后临床转归的相关影响因素。结果经^(131)I治疗后,112例中高危PTC患者中临床转归81例(72.32%)。单因素分析显示:病灶最大直径、TNM分期、手术方式、治疗前甲状腺球蛋白(Tg)水平、促甲状腺激素(TSH)、^(131)I首次治疗剂量与中高危PTC患者^(131)I治疗后临床转归有关(P<0.05),年龄、性别、病灶数量、甲状腺被膜和甲状腺外侵犯情况、病理类型、体重指数(BMI)与中高危PTC患者^(131)I治疗后临床转归无关(P>0.05);多因素分析显示:病灶最大直径≥0.42 cm、TNM分期Ⅳ期、近全切术、治疗前Tg>20 ng/mL、治疗前TSH≤30 mIU/L、^(131)I首次治疗剂量≤100 mCi是中高危PTC患者^(131)I治疗后临床转归的高危因素(P<0.05)。结论中高危甲状腺乳头状癌患者^(131)I治疗后临床转归率较高。临床转归受病灶最大直径、TNM分期、手术方式、治疗前Tg水平、TSH水平和^(131)I首次治疗剂量影响,临床需加以注意。

Objective To investigate the factors influencing the clinical turnover after ^(131)I treatment in patients with medium-and high-risk papillary thyroid carcinoma(PTC).Methods The clinical data of 112 medium-and high-risk PTC patients treated with ^(131)I were retrospectively analyzed and relevant factors influencing clinical outcome after ^(131)I treatment in patients with medium-and high-risk PTC.Results After treatment with ^(131)I,Among the 112 middle-and high-risk PTC patients,81 patients were clinically transferred(72.32%);Univariate analysis showed that the maximum diameter of the lesion,TNM stage,surgical mode,pretreatment thyroglobulin(Tg)level,thyroid stimulating hormone(TSH)and ^(131)I were associated with clinical conversion after ^(131)I treatment in patients with medium and high-risk PTC,Differences were statistically significant(P<0.05);Age,sex,number of foci,thyroid membrane and extrathyroid invasion,pathological type body mass index(BMI)were independent from clinical transposition after ^(131)I treatment in patients with medium and high risk PTC,No difference was statistically significant(P>0.05);Multivariate analysis showed that the maximum diameter≥0.42 cm,TNM stage of the lesion,near total resection,and the first treatment dose of TSH≤30mIU/L,^(131)I before Tg>20ng/mL,treatment were high risk factors affecting clinical turnover after ^(131)I treatment in patients with medium and high-risk PTC(P<0.05).Conclusion Patients with high risk papillary thyroid carcinoma were clinically transferred after ^(131)I,influenced by maximum lesion diameter,TNM stage,surgical method,pre-treatment Tg level,TSH level and first treatment dose of ^(131)I.