分化型甲状腺癌131I治疗的动态评估及影响最佳疗效反应的因素分析

目的分析影响非远处转移分化型甲状腺癌（DTC）病人术后131I治疗后获得最佳治疗（ER）的因素。方法纳入131I治疗后随访满24个月的病人160例，动态评估其治疗后3、6、12及24个月疗效反应。采用χ2检验、Fisher精确检验和Mann-Whitney U秩和检验分析不同疗效分层病人临床病理差异，应用logistic回归分析和ROC曲线分析探究影响病人最佳疗效反应的因素。结果与初始评估时相比，终末评估时ER明显升高（P < 0.01）；而ER组年龄小、ps-Tg水平较低、131I治疗次数 < 3次、131I治疗总剂量 < 500 mCi、初始危险分层低危及初始TNM分期Ⅰ~Ⅱ期的病人比例均高于非ER组（P < 0.05~P < 0.01）。血清ps-Tg是影响终末期ER的保护因素（OR=0.942，P < 0.01）。ps-Tg与初始及终末ER关系的ROC曲线下面积分别为0.884、0.762，预测非ER的最佳临界值为16.62 ng/mL和46.37 ng/mL（P < 0.01）。结论131I治疗非远处转移DTC疗效显著，血清ps-Tg对预测初始评估和终末评估疗效的具有重要价值。

Dynamic evaluation of 131I therapy for differentiated thyroid carcinoma and analysis of factors influencing the excellent response

ObjectiveTo analyze the risk factors influencing the excellent response(ER) in differentiated thyroid carcinoma(DTC) patients without distant metastasis after 131I therapy.MethodsOne hundred and sixty patients treated with 131I treatment were followed for 24 months, and the efficacy response of all cases after 3, 6, 12 and 24 months of treatment were evaluated.The clinicopathological differences of patients with different therapeutic stratification were analyzed using χ2 test, Fisher exact test and Mann Whitney U test, and the logistic regression analysis and ROC curve analysis were used to explore the factors affecting ER.ResultsCompared with the initial evaluation, the ER rate at the final evaluation significantly increased(P < 0.01).The proportion of patient with younger age, lower ps-Tg level, 131I treatment times < 3, 131I total dose < 500 mCi, low initial risk stratification and initial TNM stage Ⅰ-Ⅱ in ER group were higher those in non-ER(P < 0.05 to P < 0.01).The results of logistic multiple regression analysis showed the serum ps-Tg was a protective factor affecting end-stage ER(OR=0.942, P < 0.01).The areas under ROC curve of the relationship between ps-Tg and initial ER, and final ER were 0.884 and 0.762, respectively.The optimal critical values of predicting non-ER were 16.62 ng/mL and 46.37 ng/mL(P < 0.01).ConclusionsThe efficacy of 131I in the treatment of DTC patients without distant metastasis is significant.The serum ps-Tg is of great value in predicting the initial and final evaluation of curative effects.