淋巴结外侵犯和淋巴结转移比率与甲状腺乳头状癌放射性碘难治的相关性

Association of extranodal extension and lymph node ratio with radioactive iodine-refractory papillary thyroid cancer

目的:探讨放射性碘难治性分化型甲状腺癌(RAIR-DTC)和累积碘治疗量增加的相关因素。方法:回顾性分析郑州大学附属肿瘤医院2015年1月至2017年12月初次接受手术及碘治疗的甲状腺乳头状癌患者资料,分析RAIR-DTC和累积碘治疗量增加的相关因素。结果:共纳入650例患者,男217例(33.4%),女433例(66.6%),年龄45(34,53)岁,>55岁患者123例(18.9%),存在淋巴结外侵犯171例(26.3%),发生远处转移18例(2.8%),淋巴结转移比率0.22(0.11,0.33)。20例(3.1%)患者累积碘治疗量>400 mCi,19例(2.9%)患者出现RAIR-DTC。多因素logistic回归分析结果显示,淋巴结外侵犯( OR=19.833,95% CI:6.057~73.325, P<0.001)是累积碘治疗量增加的相关因素;年龄>55岁( OR=3.322,95% CI:1.136~9.466, P=0.024)、远处转移( OR=10.059,95% CI:2.508~38.888, P<0.001)、淋巴结外侵犯( OR=5.278,95% CI:1.707~19.813, P=0.006)和淋巴结转移比率( OR=34.724,95% CI:2.749~384.575, P=0.004)是RAIR-DTC的相关因素。 结论:淋巴结外侵犯和淋巴结转移比率均是RAIR-DTC发生的相关因素。临床上应关注不同淋巴结转移特点对RAIR-DTC发生和累积碘治疗剂量的影响。

Objective To investigate the related factors of radioiodine-refractory thyroid cancer(RAIR-DTC)and the increase of cumulative iodine treatment dose.Methods The data of patients with papillary thyroid cancer who underwent surgery and iodine treatment for the first time in the Affiliated Cancer Hospital of Zhengzhou University from January 2015 to December 2017 were retrospectively analyzed.The related factors of RAIR-DTC and the increase of cumulative iodine treatment dose were explored.Results A total of 650 patients were enrolled,including 217 males(33.4%)and 433 females(66.6%),aged 45(34,53)years.There were 123 patients(18.9%)over 55 years old,171 patients(26.3%)with extranodal extension and 18 patients(2.8%)with distant metastasis.The median lymph node ratio was 0.22(0.11,0.33).Twenty patients(3.1%)had an accumulated iodine treatment dose>400 mCi and 19 patients(2.9%)had RAIR-DTC.Multivariate logistic regression analysis showed that extranodal extension(OR=19.833,95%CI:6.057-73.325,P<0.001)was related factors for the increase of cumulative iodine treatment dose.Age>55 years old(OR=3.322,95%CI:1.136-9.466,P=0.024),distant metastasis(OR=10.059,95%CI:2.508-38.888,P<0.001),extranodal extension(OR=5.278,95%CI:1.707-19.813,P=0.006)and lymph node ratio(OR=34.724,95%CI:2.749-384.575,P=0.004)were related factors for RAIR-DTC.Conclusions Extranodal extension and lymph node ratio are related factors for RAIR-DTC.In clinical practice,more attention should be paid to the influence of different lymph node metastasis characteristics on the occurrence of RAIR-DTC and the cumulative therapeutic dose of iodine.