对分化型甲状腺癌治疗的长期副作用的关注与日俱增,最值得注意的是放射性碘(RAI)治疗。然而,已发表的关于该主题的研究有不同的队列和相互矛盾的结果.这篇评论旨在提供对已发表证据的最新评估,并阐明第二原发性恶性肿瘤(SPM)的风险,尤其是继发性血液系统恶性肿瘤(SHM),归因于RAI治疗。
在OvidMEDLINE进行了广泛的文献检索,OvidMEDLINE和过程中和其他非索引引文,OvidMEDLINEEpub在打印之前,Cochrane中央对照试验登记册(CENTRAL)和PubMed。确定了有关RAI诱导的SPM或RAI治疗与SPM之间的剂量反应关系的研究,其中10人符合分析条件。我们评估了每项研究的偏倚风险,并使用建议分级来判断所有研究的证据质量(QOE)。评估,开发和评估方法。
对于结果\"SPM\",相对效应(相对风险,危险比,或比值比)的RAI与在所有研究中,RAI的范围从1.14到1.84不等,但大多数结果没有统计学意义.对于结果“SHM”,报告的相对效应范围为1.30~2.50,其中2/3的研究结果具有统计学意义.在7/8的研究中,随着累积RAI活性的增加,SPM风险增加.关于RAI后的SPM和剂量反应关系,QOE“非常低”,和“低”为SHM后RAI。
基于低质量的证据,不能排除SPM发展的超额风险,但预计风险很小。
Concern is growing about long-term side effects of differentiated thyroid cancer treatment, most notably radioactive iodine (RAI) therapy. However, published studies on the subject have had heterogeneous cohorts and conflicting results. This
review seeks to provide an updated evaluation of published evidence, and to elucidate the risk of second primary malignancies (SPMs), especially secondary hematologic malignancies (SHMs), attributable to RAI therapy.
An extensive literature search was performed in Ovid MEDLINE, Ovid MEDLINE and In-Process & Other Non-Indexed Citations, Ovid MEDLINE Epub Ahead of Print, Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed. Studies regarding RAI-induced SPMs or a dose-response relationship between RAI therapy and SPMs were identified, 10 of which were eligible for the analysis. We evaluated risk of bias in each study and judged quality of evidence (QOE) across all studies using the Grading of Recommendations, Assessment, Development and Evaluations approach.
For the outcome \"SPM\", the relative effect (relative risk, hazard ratio, or odds ratio) of RAI vs. no RAI ranged from 1.14 to 1.84 across studies, but most results were not statistically significant. For the outcome \"SHM\", reported relative effects ranged from 1.30 to 2.50, with 2/3 of the studies presenting statistically significant results. In 7/8 of the studies, increased risk for SPM was shown with increasing cumulative RAI activity. QOE was \"very low\" regarding SPM after RAI and regarding a dose-response relationship, and \"low\" for SHM after RAI.
Based on low quality evidence, an excess risk for the development of SPM cannot be excluded but is expected to be small.