分化型甲状腺癌功能性远处转移灶的临床特征及 131I治疗效果观察

Clinical feature and effectiveness of 131I treatment for functional distant metastasis of differentiated thyroid cancer

目的:分析分化型甲状腺癌(DTC)伴功能性远处转移(DM-DTC)患者的临床特征,观察 131I对该类患者的治疗效果。 方法:回顾分析2008年8月至2021年1月河南省人民医院功能性DM-DTC患者13例,其中男4例、女9例,年龄26~75岁。收集分析患者DTC病理类型、转移灶大小、转移部位及首次 131I治疗前促甲状腺激素(TSH)等资料。以实体瘤疗效评价标准(RECIST)1.1联合甲状腺球蛋白(Tg)评价 131I治疗效果,以完全缓解(CR)及部分缓解(PR)为有效。采用Wilcoxon符号秩检验分析 131I治疗前后转移灶最大径变化。 结果:13例功能性DM-DTC患者中,甲状腺滤泡状癌8例,甲状腺乳头状癌5例;转移主要累及肺(12例)及骨骼(6例);转移灶最大径≥1 cm者12例;首次 131I治疗前TSH≥30 mU/L者3例。9例患者通过RECIST 1.1评估为PR,3例通过RECIST 1.1及Tg值评估为CR,1例通过Tg变化评估为PR;功能性DM-DTC患者的 131I治疗均有效(13/13)。与 131I治疗前相比,治疗后转移灶最大径明显缩小[2.6(1.6,3.3)与1.2(0.1,2.2) cm;z=-3.06, P=0.002]。 结论:功能性DM-DTC患者以滤泡状癌亚型居多,转移灶最大径≥1 cm占比高,首次 131I治疗前TSH≥30 mU/L的比例低, 131I治疗有效率高。

ObjectiveTo summarize the clinical feature of functional distant metastasis(DM)of differentiated thyroid cancer(DTC)and observe the efficacy of 131I treatment.MethodsBetween August 2008 and January 2021,a total of 13 DTC patients(4 males,9 females;age 26-75 years)with functional DM from Henan Provincial People′s Hospital were retrospectively analyzed.Clinical data of patients were collected,including pathological type,metastasis size,metastasis location,and thyroid stimulating hormone(TSH)before the first 131I treatment.Efficacy of 131I treatment in patients with functional DM-DTC was evaluated by response evaluation criteria in solid tumors(RECIST)1.1 and thyroglobulin(Tg).Complete remission(CR)and partial remission(PR)were considered as effective.Wilcoxon signed rank test was used to analyze the maximum diameter change of metastatic lesions before and after 131I treatment.ResultsAmong 13 DM-DTC patients,8 were follicular thyroid cancer(FTC),5 were papillary thyroid cancer(PTC).Metastasis lesions were mainly located in lungs(n=12)and bones(n=6).There were 12 patients with maximum metastasis diameter≥1 cm,and 3 patients with TSH≥30 mU/L before the first 131I treatment.Nine patients were assessed as PR by RECIST 1.1,3 patients were assessed as CR by RECIST 1.1 and the value of Tg,and 1 patient was assessed as PR by the changing of Tg.The effective rate of 131I treatment for patients with functional DM-DTC was 13/13.The maximum metastasis diameter was significantly decreased after 131I treatment(2.6(1.6,3.3)vs 1.2(0.1,2.2)cm;z=-3.06,P=0.002).ConclusionPatients with functional DM-DTC are characterized by high proportion of FTC and the maximum metastasis diameter≥1 cm,low proportion of TSH≥30 mU/L before the first 131I treatment,and high effective rate of 131I treatment.