放射性~(131)Ⅰ去除分化型甲状腺癌术后残留甲状腺组织的疗效与影响因素分析

目的研究应用放射性131Ⅰ首次去除分化型甲状腺癌(DTC)术后残留甲状腺组织的疗效及其影响因素。方法 DTC患者51例,其中,甲状腺乳头状癌48例,滤泡状癌3例。所有DTC患者均行外科手术治疗,并于术后平均15个月内给予131I治疗,剂量为(2.96～5.55)GBq(80～150mCi),131Ⅰ治疗后平均6个月行第2次大剂量131Ⅰ治疗,并于7d后行131Ⅰ全身显像,甲状腺部位无残留甲状腺组织显影被认为首次"清甲"成功。影响因素采用t检验、χ2检验进行单因素分析、binary Logistic回归方法进行多因素分析。结果 51例DTC患者,首次"清甲"成功者22例(占43%)、未成功者29例(占57%)。残留甲状腺组织的大小(χ2=4.965,P=0.026)、首次手术距"清甲"治疗的时间(Z=-2.631,P=0.009)、"清甲"前血清促甲状腺激素(TSH)水平(Z=-2.149,P=0.032)、"清甲"前血清甲状腺球蛋白(Tg)水平(Z=-2.815,P=0.005)及"清甲"前有无转移(χ2=12.466,P=0.002)是"清甲"成功与否的影响因素。Binary Logistic回归分析结果表明,"清甲"前血清TSH(Wald=4.209,P=0.040)及Tg水平(Wald=4.563,P=0.033)是"清甲"成功与否的影响因素。结论 131Ⅰ首次去除DTC术后残留甲状腺组织患者术后残留甲状腺组织少、首次手术距"清甲"治疗间隔时间短、TSH水平高、Tg水平低及无甲状腺外转移者,其"清甲"成功率较高。其中,"清甲"前血清TSH及Tg水平是影响首次"清甲"成功率的最重要因素。

Efficacy and influencing factors of radioactive mI for elimination of thyroid remnants following differentiated thyroid carcinoma resection

Objective To investigate the efficacy and influencing factors of radioactive 131I on residual thyroid tissues following differentiated thyroid carcinoma （DTC） resection. Methods A total of 51 patients with DTC, including 48 with papillary thyroid carcinoma and 3 with follicular thyroid carcinoma, were recruited in the study. All patients underwent 131I radiotherapy [（2.96-5.55） GBq] following a mean of 15.2 months postoperatively. Subsequent high-dose 13q radiotherapy was performed at month 6. This entailed3＇I systemic imaging at day 7 thereafter. Initial thyroid ablation was regarded as successful provided that residual thyroid gland was absent on mI systemic imaging. Univariate analysis using t-test and X2 test, and multivariate analysis using binary Logistic model were conducted. Results Of 51 patients enrolled in the study, 22 （43%） achieved initial thyroid remnant ablation and 29 （57%） failed. Univariate analysis suggested that the thyroid residual volume （X2=4.965, P=0.026）, the interval from initial re- section to initial 13~I ablation （Z=-2.631, P=0.009）, serum TSH （Z--2.149, P=0.032）, serum Tg （Z=-2.815, P=0.005） and presence of metastasis （X2=12.466, P=0.002） prior to 3I ablation therapy were the influencing factors reflecting outcomes of mI ablation. Binany loqistic regression analysis showed that serum TSH （Wald--4.209, P=-0.040）, serum Tg （Wald=4.563, P=0.033） were influencing factors of 3I ablation therapy. Conclusion Initial ablation of thyroid rem- nant using mI radiotherapy yields a successful rate of 43%. Patients with DTC showing reduced thyroid residual vol- ume, shortened interval from initial resection surgery to initial mI ablation, higher serum TSH, lower serum Tg, absence of extrathyroidal metastasis are associated with a higher success rate of 13I radiotherapy. Among them, the serum TSH and T are the most important factors of the success of ＇hi radiotherapy for elimination of thyroid remnants.