131 I治疗分化型甲状腺癌伴肺转移的疗效及影响因素分析

目的 分析131 I治疗分化型甲状腺癌(DTC)伴肺转移的疗效、影响因素以及不良反应.方法 回顾性分析49例接受131 I治疗的DTC伴肺转移患者.影响因素包括年龄、性别、累积剂量、病理学类型、显像时机、摄131 I形态、治疗前Tg水平、颈部淋巴结转移等.统计学方法包括t检验、χ2检验及Logistic回归分析.同时,观察131 I治疗和随访期间的不良反应.结果 131 I治疗DTC伴肺转移的有效率为63.3%(31/49),无效率为36.7%(18/49).单因素分析显示:年龄(t=4.194,P<0.001),治疗前Tg水平(t=3.632,P<0.05),胸片和(或)CT显示(χ2=7.385,P<0.05),伴其他远处转移(χ2=8.586,P<0.05)及显像时机(χ2=8.077,P<0.05)5个因素与131 I疗效有关;Logistic回归分析显示:年龄、伴其他远处转移及治疗前Tg水平是131 I治疗DTC伴肺转移疗效的独立影响因素.131 I治疗对患者造血功能、肝功能等无明显影响,仅有少部分患者会出现唾液腺功能受损.结论 131 I是治疗DTC伴肺转移的有效手段,不良反应少,其中年龄小、治疗前Tg水平低以及仅肺转移的患者131 I疗效好.

Analysis of the efficacy and influence factors of 131 I therapy for lung metastases of differentiated thyroid carcinoma

Objective To analyze the efficacy, influence factors and side effects of 131 I therapy for lung metastases of differentiated thyroid carcinoma ( DTC ) . Methods 49 patients with lung metastases of DTC who received 131 I treatment were retrospectively analyzed. Influence factors included patients′age, gender, cumulative doses, patho-logical classification, times of lung metastases by 131 I imaging, 131 I uptake pattern, Tg levels before treatment, cer-vical lymph node metastases and so on. Statistical methods included t test,χ2 test and Logistic regression analysis. Meantime, the side effects were observed during the 131 I treatment and follow-up period. Results The rates of par-tial response and invalidity of 131 I treatment DTC with lung metastases were 63. 3%( 31/49 ) and 36. 7%( 18/49 ) respectively. Univariate analysis showed that:age(t=4. 194, P<0. 001), Tg levels before treatment(t=3. 632, P<0. 05), Chest X-ray and(or) CT finding(χ2 =7. 385, P<0. 05), other distant metastases(χ2 =8. 586, P<0. 05), times of lung metastases by 131I imaging(χ2 =8. 077,P<0. 05) were the factors influencing outcome of 131I treatment. Logistic regression analysis showed that the influence factors included age, Tg levels before treatment and other distant metastases. 131 I treatment had no significant effect on hematopoietic function and liver function, but salivary gland function of some patients was impaired. Conclusion 131 I therapy is effective and safe for lung metastases of DTC, and the younger, the significant decrease of Tg levels before treatment and only lung metastases indicate a well prognosis.