碘难治性分化型甲状腺癌的预后及影响因素分析

Analysis of prognosis and influencing factors in radioiodine refractory differentiated thyroid cancer

目的分析碘难治性分化型甲状腺癌(RAIR-DTC)患者的预后及影响因素。方法回顾性分析2016年10月至2020年1月于中国医学科学院肿瘤医院核医学科行^(131)I治疗无效的52例RAIR-DTC患者。根据治疗后5年内疾病是否进展分为进展组及疾病稳定组,通过卡方检验和Logistic回归比较两组间的差异;构建Cox风险模型确定预后的独立危险因素;Kaplan-Meier法(log-rank方法进行检验)评估治疗方法对进展组预后的影响。结果52例患者的3年及5年生存率分别为88.5%、73.1%,进展者分别为81.8%、57.6%,稳定者分别为100%、100%,两组在年龄、是否存在甲状腺外浸润以及首次^(131)I治疗剂量中存在显著差异(P<0.05)。单因素分析表明患者的年龄、首次^(131)I治疗前血清刺激性甲状腺球蛋白(ps-Tg)、首次治疗前中性粒细胞与淋巴细胞比值(NLR)及复发转移部位与总生存期显著相关(P<0.05),多因素分析表明年龄>55岁(HR=12.40,95%CI=2.09~73.57,P=0.001)、存在远处转移(HR=24.47,95%CI=4.17~143.75,P<0.001)是RAIR-DTC预后的独立危险因素。在进展组行局部手术治疗和/或靶向治疗可明显延长无进展生存期(P<0.001)。结论RAIR-DTC的预后较差,高龄及远处转移与不良预后显著相关。高龄、存在甲状腺外浸润的患者可在首次^(131)I治疗时适当提高治疗剂量延缓疾病进展,出现进展者建议及时行局部手术治疗或/和靶向治疗。

Objective To analyze the prognosis and influencing factors in patients with radioiodine-refractory differenti-ated thyroid cancer(RAIR-DTC).Methods A retrospective analysis was conducted on 52 patients with RAIR-DTC who underwent ineffective ^(131)I therapy at the Department of Nuclear Medicine,Cancer Hospital,Chinese Academy of Medical Sciences from October 2016 to January 2020.Patients were categorized into progression and stable groups based on disease progression within five years post-treatment.Differences between groups were analyzed using chi-square test and logistic re-gression.Independent prognostic risk factors were identified using a Cox proportional hazards model.The Kaplan-Meier method with log-rank test was used to evaluate the impact of treatment on the prognosis of the progression group.Results The 3-year and 5-year survival rates of the 52 patients with RAIR-DTC were 88.5%and 73.1%,respectively.In the progression group,the rates were 81.8%and 57.6%.In the stable group,the rates were 100%and 100%.There were sig-nificant differences between the two groups in terms of age,presence of extrathyroidal extension,and the initial ^(131)I treat-ment dose(P<0.05).Univariate analysis indicated that the age,pre-ablation stimulated thyroglobulin level before the first ^(131)I treatment,the neutrophil-to-lymphocyte ratio before the first treatment,and the sites of recurrence and metastasis were significantly associated with overall survival(P<0.05).Multivariate analysis showed that age>55 years(HR=12.40,95%CI=2.09-73.57,P=0.001)and distant metastasis(HR=24.47,95%CI=4.17-143.75,P<0.001)were independent risk factors for poor prognosis.Kaplan-Meier curve analysis showed that local surgery and/or targeted therapy significantly prolonged progression-free survival in the progression group(P<0.001).Conclusion The prognosis for RAIR-DTC is poor,with ad-vanced age and distant metastasis significantly associated with unfavorable outcomes.In elderly patients and those with ex-trathyroidal invasion,the treatment dose during initial ^(131)I therapy may be appropriately increased to delay disease progres-sion.For patients with disease progression,prompt local surgical intervention and/or targeted therapy is recommended.