经验性^(131)I治疗Rx-WBS阴性伴生化耐药分化型甲状腺癌患者的疗效观察

Observation on the efficacy of empirical ^(131)I therapy in differentiated thyroid cancer with negative Rx-WBS and biochemical incomplete response

目的观察经验性^(131)I治疗在治疗后全身显像(Rx-WBS)阴性伴生化疗效不佳(BIR)分化型甲状腺癌(DTC)患者中的疗效。方法回顾性收集2013-09-01-2020-09-30在山东省肿瘤医院行甲状腺全切或近全切术及二次放射性碘治疗(RAI)后Rx-WBS阴性、疗效评价为BIR的DTC患者的临床资料,共纳入52例甲状腺球蛋白(Tg)阳性的患者,26例行经验性^(131)I治疗患者纳入经验性RAI组,另26例纳入对照组。应用χ^(2)检验或Fisher确切概率法和Mann-Whitney U检验分析经验性RAI组和对照组患者血清Tg水平的变化趋势及^(131)I治疗的疗效。结果在Tg水平持续阳性的患者中,经验性RAI组抑制性Tg水平(iTg)为0.89(0.67~1.71)ng/mL,低于对照组的2.46(1.56~4.23)ng/mL,Z=-3.056,P=0.002。经验性RAI组生化缓解率为53.85%(14/26),高于对照组的15.38%(4/26),χ^(2)=8.497,P=0.004。结论在Rx-WBS阴性伴持续BIR的DTC患者中,经验性^(131)I治疗对于Tg水平阳性的患者有一定价值。

Objective To observe the efficacy of empirical^(131)I therapy in differentiated thyroid cancer(DTC) with negative post-therapy whole-body scan(Rx-WBS) and biochemical incomplete response(BIR).Methods Sixty-one DTC patients with negative Rx-WBS and BIR after the second radioactive iodine(RAI) who underwent total or near-total thyroidectomy and^(131)I therapy were analyzed retrospectively from September 1,2013 to September 30,2020 in Shandong Cancer Hospital.There were 52 patients with positive thyroglobulin(Tg).Among them, 26 patients were treated with empirical^(131)I therapy as the empirical RAI group, and the other 26 patients were the control group.χ^(2) test or Fisher exact test, and Mann-Whitney U test were used to analyze the changes in serum Tg levels and the response to therapy between the empirical RAI group and control group.Results In patients with positive Tg levels, the iTg level was lower in the empirical RAI group than that in the control group [0.89(0.67-1.71) vs 2.46(1.56-4.23) ng/ml, Z=-3.056,P=0.002].Moreover, the biochemical remission rate in the empirical RAI group was higher that in the control group [53.85%(14/26) vs 15.38%(4/26),χ^(2)=8.497,P=0.004].Conclusion In DTC patients with negative Rx-WBS and persistent BIR,empirical^(131)I therapy has certain significance in patients with positive Tg levels.