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放射性碘难治性分化型甲状腺癌的临床病理特征

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目的 探讨放射性碘难治性分化型甲状腺癌(RAIR-DTC)的临床病理特征,为甲状腺癌患者早期预测放射性碘难治(RAIR)提供临床依据。方法 回顾性分析2010年1月至2019年12月于解放军第九六○医院行甲状腺切除术并行1311治疗的84例患者的病例资料,将诊断为RAIR-DTC的39例患者作为研究组,将诊断为碘治疗有效性分化型甲状腺癌(RAIA-DTC)的45例患者作为对照组。比较两组临床病理特征,logis-tic 回归分析RAIR-DTC的独立危险因素,并确立RAIR-DTC预测模型。结果 与RAIA-DTC组 比较,RAIR-DTC组碘治疗次数更多,≥55岁、总碘治疗剂量、远处转移、TNM Ⅳ期患者比例、高危亚型和局灶钙化比例更高,肿瘤最大径更大,淋巴结转移数量更多,Ⅱ、Ⅰ+Ⅱ和非中央区淋巴结转移概率更高(P<0。05)。两组无进展生存率比较,差异有统计学意义(P<0。05);两组总生存率比较,差异无统计学意义(P>0。05)。二元logistic回归分析结果显示,远处转移、高危亚型、肿瘤最大径≥10。5 mm是RAIR-DTC的独立危险因素(P<0。05)。获得拟合方程式logit(P)=-2。259+3。330X1+2。287X2+1。606X3,采用ROC曲线计算拟合方程式的截断值为-0。312 5,若logit(P)>-0。312 5时,其可能发展为RAIR-DTC。结论 分化型甲状腺癌患者临床病理特征可有效预测RAIR。
Clinicopathological features of radioactive iodine-refractory differentiated thyroid cancer
Objective To investigate the clinicopathological characteristics of radioactive Iodine-refrac-tory differentiated thyroid cancer(RAIR-DTC)to provide a clinical evidence for early prediction of the thyroid cancer patients with radioactive Iodine-refractory(RAIR).Methods The data of 84 patients with undergoing thyroidectomy and 131I therapy in PLA 960 hospital from January 2010 to December 2019 were retrospectively analyzed.Thirty-nine patients with diagnosed RAIR-DTC served as the study group and 45 cases of radioactive iodine-avid differentiated thyroid cancer(RAIA-DTC)served as the control group.The clinicopathological characteristics were compared between the two groups.The logistic regression was used to analyze the inde-pendent risk factors of RAIR-DTC,and the RAIR-DTC prediction model was established.Results Compared with the RAIA-DTC group,the RAIR-DTC group had more iodine treatment times,the proportions of the pa-tients with age ≥55 years old,total iodine therapeutic dose,distant metastasis,TNM stage Ⅳ,high-risk sub-types and focal calcification were higher,the tumor maximum diameter was greater,the number of lymph node metastases was more and the probability of Ⅱ,Ⅰ+Ⅱ and non-central lymph node metastases was higher(P>0.05).The progression-free survival rate had statistical difference between the two groups(P<0.05).The total survival rate had no statistical difference between the two groups(P>0.05).The binary logistic re-gression analysis results showed that the distant metastasis,high-risk histological subtype and maximum tumor diameter ≥10.5 mm were the independent risk factors for RAIR-DTC.The obtained fitting equation logit(P)=-2.259+3.330X1+2.287X2+1.606X3,the ROC curve was used to calculate the truncation val-ue of the fitted equation as-0.312 5,when logit(P)>-0.312 5,it might develop into RAIR-DTC.Conclusion The clinicopathological characteristics of the patients with differentiated thyroid cancer could ef-fectively predict RAIR.

differentiated thyroid carcinomaIodine-refractorypapillary thyroid carcinomafollicular carcinomadistant metastasis

姜贝贝、李帅、刘稳、薛景丽、李敏、李培峰

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锦州医科大学解放军第九六○医院研究生培养基地,济南 250031

济南市第四人民医院病理科,济南 250031

解放军第九六○医院核医学科,济南 250031

解放军第九六○医院病理科,济南 250031

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分化型甲状腺癌 放射性碘难治 乳头状癌 滤泡性癌 远处转移

山东省自然科学基金面上项目山东省医药卫生科技发展计划

ZR2023MH029202201041061

2024

重庆医学
重庆市卫生信息中心,重庆市医学会

重庆医学

CSTPCD
影响因子:1.797
ISSN:1671-8348
年,卷(期):2024.53(1)
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