摄碘阳性的分化型甲状腺癌淋巴结转移灶131I疗效分析

背景与目的：淋巴结转移（lymph node metastasis，LNM）是分化型甲状腺癌（differentiated thyroid carcinoma，DTC）最常见的转移，而¹³¹I对LNM的疗效存在争议，本研究旨在明确¹³¹I对摄碘良好的LNM的疗效及影响因素。方法：纳入2015年1月—2019年6月在上海交通大学医学院附属新华医院接受¹³¹I治疗的90例DTC患者，共计161个摄碘阳性的转移淋巴结。分析患者的临床及影像学资料，应用SPSS 24.0软件进行统计分析。计量资料按照正态分布，进行独立样本t检验比较，计数资料的比较采用χ²检验，用logistic回归进行多因素分析，建立多个定量指标与结局为¹³¹I治疗无效的关系间的受试者工作特征（receiver operating characteristic，ROC）曲线，并得到最佳诊断阈值。结果：161个摄碘阳性的转移淋巴结中，有效组为71个（44.10%），无效组为90个（55.90%）。单因素分析提示，两组患者在年龄、性别、病理学类型、原发病灶数量、原发病灶位置、有无远处转移及血清甲状腺球蛋白（thyroglobulin，Tg）水平等方面差异均有统计学意义（P <0.05）。多变量logistic回归分析显示，病理学类型（OR = 11.827，95% CI：1.128 ~ 123.978，P = 0.039）、有无远处转移（OR = 0.220，95% CI：0.093 ~ 0.522，P = 0.001）和原发病灶数量（OR = 0.421，95% CI：0.212 ~ 0.837，P = 0.014）与治疗后的转归密切相关。结论：原发病灶多灶、病理学类型为甲状腺乳头状癌（papillary thyroid carcinoma，PTC）、远处转移、血清Tg高于43.51 ng/mL及转移淋巴结的最大径大于16.8 mm是摄碘阳性淋巴结¹³¹I治疗无效的危险因素，建议对此类患者加大治疗剂量或尽早选择手术切除。

Analysis of therapeutic response of iodine positive metastasis lymph nodes in differentiated thyroid cancer after 131I treatment

Background and purpose: Lymph node metastasis (LNM) is the most common metastasis of differentiated thyroid cancer (DTC), and the efficacy of ¹³¹I on LNM is controversial. The aim of this study was to clarify the efficacy of ¹³¹I on LNM with good iodine uptake and the influencing factors. Methods: In this study, 161 iodine positive metastasis lymph nodes from 90 DTC patients treated by ¹³¹I from January 2015 to June 2019 in Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine were included, and the clinical and imaging data of the patients were analyzed. SPSS 24.0 software was used to make statistical analysis. The measurement data were distributed according to the normal distribution, then the independent sample t-test was compared. The comparison of the counting data was conducted by χ² test, and the multivariate analysis was carried out by logistic regression analysis. The receiver operating characteristic (ROC) curve between multiple quantitative indexes and the failure of ¹³¹I treatment were established, and the optimal diagnostic threshold was obtained. Results: Among 161 iodine positive metastasis lymph nodes, 71 (44.10%) were effective, and 90 (55.90%) were ineffective. Univariate analysis showed that there were significant differences in age, gender, pathological type, number of primary lesions, location of primary lesions, distant metastasis and serum thyroglobulin (Tg) level between the two groups (P<0.05). Multivariate logistic regression analysis showed that the pathological types (OR = 11.827, 95% CI: 1.128-123.978, P = 0.039), distant metastasis (OR = 0.220, 95% CI: 0.093-0.522, P = 0.001) and number of primary lesions (OR = 0.421, 95% CI: 0.212-0.837, P = 0.014) were closely related to the outcome of the treatment. Conclusion: Multiple primary foci, papillary thyroid carcinoma (PTC), distant metastasis, serum Tg higher than 43.51 ng/mL and the maximum diameter of metastatic lymph nodes greater than 16.8mm are the risk factors of ineffective ¹³¹I treatment. Increasing the treatment dose or choosing surgical resection as soon as possible is recommended for those patients.