摘要
目的 分析中危和高危复发风险的甲状腺乳头状癌(papillary thyroid cancer,PTC)放射性碘(radioactive iodine,RAI)治疗的有效性.方法 回顾性分析2010年10月至2020年1月在中南大学湘雅医院甲状腺外科行甲状腺癌手术治疗的709例PTC的临床资料,男226例,女483例.根据初次术后是否行RAI治疗分为RAI组(中危253例,高危209例)和非RAI组(中危147例,高危100例),通过x2检验或Fisher精确检验、Logistic回归分析等方法分析中危和高危PTC行RAI治疗与性别、年龄、肿瘤大小等临床病理特征的关系,Kaplan-Meier法计算无复发生存率.结果 中危PTC患者RAI治疗率63.25％(253/400),高危PTC患者RAI治疗率67.64％(209/309).中危PTC患者单因素分析显示:年龄、双侧肿瘤、淋巴结转移(lymph node metastasis,LNM)分期、LNM数目和中危PTC患者RAI治疗密切相关(P值均＜0.05).中危PTC患者多因素回归分析结果:年龄≥55岁(OR=0.282,P=0.005)、LNM分期N1b(OR=19.245,P＜0.001)、LNM数目≤5个(OR=0.322,P＜0.001)是中危PTC患者RAI治疗的独立预测因素(P值均＜0.05).中危PTC无复发生存曲线显示RAI组无复发生存率低于非RAI组,差异有统计学意义(P=0.049).高危PTC单因素分析显示:年龄、多灶肿瘤、双侧肿瘤、LNM分期、LNM数目和高危PTC患者RAI治疗密切相关(P值均＜0.05).高危PTC多因素回归分析结果:年龄≥55岁(OR=0.382,P=0.020)、双侧肿瘤(OR=2.173,P=0.030)、LNM分期N1 b(OR=11.215,P＜0.001)、LNM数目≤5个(OR=0.389,P=0.004)是高危PTC患者RAI治疗的独立预测因素(P值均＜0.05).高危PTC无复发生存曲线显示RAI组无复发生存率低于非RAI组,但差异无统计学意义(P=0.07).结论 中危和高危PTC患者RAI治疗未观察到明显益处,建议严格筛选符合RAI治疗条件的患者.
Abstract
Objective To analyze the effectiveness of radioactive iodine(RAI)treatment for papillary thyroid cancer(PTC)with an intermediate and high risk of recurrence.Methods The clinical data of 709 cases of PTC,comprising 226 men and 483 women,who underwent surgical treatment for thyroid cancer at Xiangya Hos-pital of Central South University from Oct.2010 to Jan.2020 were retrospectively analyzed.According to whether RAI treatment was performed after initial surgery or not,they were divided into a RAI group(253 cases with inter-mediate risk and 209 cases with high risk)and a non-RAI group(147 cases with intermediate risk and 100 cases with high risk),and the relationship between RAI treatment and clinicopathological characteristics such as sex,age,and tumor size for intermediate-and high-risk PTC was analyzed by x2 test or Fisher's exact test and Logistic regression analysis.The Kaplan-Meier method was used to calculate the recurrence-free survival rate.Results The treatment rate of intermediate-risk PTC RAI was 63.25％(253/400)and that of high-risk PTC RAI was 67.64％(209/309).Univariate analysis of intermediate-risk PTC showed that age,bilateral tumors,lymph node me-tastasis stage,number of lymph node metastases,and intermediate-risk PTC RAI treatment were closely related(all P values＜0.05).Multi-factor regression analysis of intermediate-risk PTC showed that age ≥ 55(OR=0.282,P=0.005),lymph node metastasis stage N1b(OR=19.245,P＜0.001),and the number of lymph node metastases ≤ 5(OR=0.322,P＜0.001)were independent predictors of RAI treatment for intermediate-risk PTC(all P values＜0.05).The recurrence-free survival curve for intermediate-risk PTC showed a lower recurrence-free survival rate in the RAI group than in the non-RAI group,but the difference was borderline significant(P=0.049).Univariate analysis of high-risk PTC showed that age,multifocal tumors,bilateral tumors,lymph node metastasis stage,number of lymph node metastases and high-risk PTC RAI treatment were strongly associated(all P values＜0.05).Multifactori-al regression analysis for high-risk PTC showed that age ≥ 55(OR=0.382,P=0.020),bilateral tumors(OR=2.173,P=0.030),lymph node metastasis stage N1b(OR=11.215,P＜0.001),and the number of lymph node metastases ≤5(OR=0.389,P=0.004)were independent predictors of RAI treatment for high-risk PTC patients(all P values＜0.05).The recurrence-free survival curve for high-risk PTC showed a lower recurrence-free survival rate in the RAI group than in the non-RAI group,however,the difference was not statistically significant(P=0.07).Conclusions No significant benefit was observed with RAI treatment for intermediate-and high-risk PTC and rigorous screening of eligible patients is recommended.
维普
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