家族性分化型甲状腺癌131I初次治疗后的疗效分析

目的探究家族性分化型甲状腺癌(FDTC)与散发性分化型甲状腺癌(SDTC)患者的临床病理特征及¹³¹I初次治疗的疗效差异。方法对2010年1月至2018年8月间于华中科技大学同济医学院附属协和医院核医学科进行¹³¹I治疗的66例FDTC患者[男19例、女47例,年龄(39.8±11.7)岁]与1701例SDTC患者[男442例、女1259例,年龄(40.9±11.3)岁]进行回顾性分析。比较2组患者间年龄、性别、病理类型、肿瘤最大径、单双侧、多灶性、结节性甲状腺肿、甲状腺炎、被膜侵犯、淋巴结转移、周围软组织侵犯、远处转移、TNM分期及美国甲状腺协会(ATA)危险度分层(低危、中危、高危)等临床病理特征、术后¹³¹I治疗前刺激性甲状腺球蛋白(ps-Tg)和刺激性甲状腺球蛋白抗体(ps-TgAb)水平及治疗后反应(疗效满意、疗效不确切、生化疗效不佳、结构性疗效不佳)。采用χ²检验或Fisher确切概率法和两独立样本t检验分析数据。结果FDTC组与SDTC组比较,在双侧病灶[45.5%(30/66)与31.2%(530/1701);χ²=5.999,P=0.010]、被膜侵犯[43.9%(29/66)与26.6%(452/1701);χ²=9.672,P=0.002]及远处转移[15.2%(10/66)与6.2%(105/1701);χ²=8.418,P=0.004]所占比例中较高;在危险度分层中,2组高危占比分别为18.2%(12/66)与9.2%(156/1701),中危占比分别为68.2%(45/66)与72.7%(1237/1701),低危占比分别为13.6%(9/66)与18.1%(308/1701),差异有统计学意义(χ²=6.898,P=0.030);但FDTC肿瘤最大径小于SDTC组[(1.24±0.74)与(1.50±0.92)cm;t=-2.275,P=0.020],余临床病理特征指标在2组间的差异均未见统计学意义(t=-0.804,χ²值:0.101~5.359,均P>0.05)。术后ps-Tg、ps-TgAb水平及治疗后反应在2组间的差异亦无统计学意义(χ²值:0.059~1.915,均P>0.05)。结论FDTC患者较SDTC患者的肿瘤更具侵袭性;2组患者初始治疗后疗效没有明显差异。

Analysis of curative effect after initial131I treatment of familial differentiated thyroid cancer

Objective To explore the clinical pathological characteristics and initial¹³¹I curative responses of familial differentiated thyroid cancer(FDTC)and sporadic differentiated thyroid cancer(SDTC).Methods A total of 66 FDTC patients(19 males,47 females,age(39.8±11.7)years)and 1701 SDTC patients(442 males,1259 females,age(40.9±11.3)years)who underwent¹³¹I therapy in Department of Nuclear Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology between January 2010 and August 2018 were retrospectively enrolled.The clinical pathological characteristics,preablative stimulated thyroglobulin(ps-Tg),preablative stimulated thyroglobulin antibody(ps-TgAb)and response to initial therapy(excellent response,indeterminate response,biochemical incomplete response,structural incomplete response)of two groups were analyzed and compared.The clinical pathological parameters included age,gender,pathological type,tumour maximum diameter,bilateral,multifoci,nodules goiter,thyroiditis,thyroid membrane invasion,lymph node metastasis(LNM),invasion of the surrounding soft tissues,distant metastasis,TNM staging and American Thyroid Association(ATA)risk stratification(low-risk,intermediate-risk,high-risk).χ² test or Fisher exact test and independent-sample t test were used to compare the data between two groups.Results Comparing with SDTC group,FDTC group showed higher proportion of bilateral foci(45.5%(30/66)vs 31.2%(530/1701);χ²=5.999,P=0.010),thyroid membrane invasion(43.9%(29/66)vs 26.6%(452/1701);χ²=9.672,P=0.002)and distant metastasis(15.2%(10/66)vs 6.2%(105/1701);χ²=8.418,P=0.004).There was a statistical difference in risk stratification between two groups(high-risk:18.2%(12/66)vs 9.2%(156/1701);intermediate-risk:68.2%(45/66)vs 72.7%(1237/1701);low-risk:13.6%(9/66)vs 18.1%(308/1701);χ²=6.898,P=0.030).But the tumor maximum diameter of FDTC group was smaller than that of SDTC group((1.24±0.74)vs(1.50±0.92)cm;t=-2.275,P=0.020).There were no significant differences in other clinical pathological parameters between FDTC group and SDTC group(t=-0.804,χ² values:0.101-5.359,all P>0.05).There were no significant differences between two groups in the postoperation ps-Tg,ps-TgAb levels and the response to initial therapy after¹³¹I treatment(χ² values:0.059-1.915,all P>0.05).Conclusions The FDTC group displays distinct characteristics as increased aggressiveness at diagnosis.But after accurately treatment,there is no significant difference in the response to therapy between two groups.