目标:这个单一中心,观察性病例对照可行性研究旨在测试方案的关键要素,以最终对较大患者队列进行长期国际观察性病例对照研究。评估在儿童或青春期接受放射性碘治疗(RAI)的分化型甲状腺癌(DTC)女性患者中,乳腺癌作为第二原发性恶性肿瘤的风险。患者:纳入白俄罗斯切尔诺贝利事故后出现DTC且甲状腺手术时年龄≤19岁的女性:接受RAI的患者(n=111)和未接受RAI的相似年龄的对照组(n=90)。结果:RAI患者中有1例新诊断为乳腺癌,但没有控制。接受RAI的患者需要第二次手术的频率明显低于对照组(23%,26/111vs.39%,35/90,P<0.05);此类手术的主要指征通常是怀疑局部复发。RAI患者的生殖困难似乎比对照组更频繁:前者的78%(87/111)其中93%(84/90)有妊娠史(P<0.01),RAI患者的平均怀孕次数为1.5±1.2。对照组为1.9±1.1(P<0.05)。最值得注意的是,在23%(26/111)的RAI患者中观察到不孕症对照组的4%(4/90)(P<0.01)。总之,一项关于接受RAI与DTC治疗的患者DTC后乳腺癌的国际观察性病例对照研究没有给予RAI似乎是可行的。年轻女性RAI后的生殖功能应进行其他研究和日常临床关注。
Objective: This single-center, observational
case-control feasibility study sought to test key elements of a protocol for an eventual long-term international observational
case-control study of a larger patient cohort, to evaluate the risk of breast cancer as a second primary malignancy in females with differentiated thyroid cancer (DTC) given radioiodine therapy (RAI) during childhood or adolescence. Patients: Females developing DTC after the Chernobyl accident in Belarus and ≤19 years old at the time of thyroid surgery were enrolled: patients given RAI (n = 111) and controls of similar age not given RAI (n = 90). Results: One
case of breast cancer was newly diagnosed among the RAI patients, but none in controls. Patients given RAI significantly less frequently needed 2nd surgeries than did controls (23%, 26/111 vs. 39%, 35/90, P < 0.05); the main indication for such procedures usually is suspicion of local recurrence. RAI patients appeared to have had more frequent reproductive difficulties than did controls: 78% (87/111) of the former vs. 93% (84/90) of the latter had a history of pregnancy (P < 0.01), and the mean number of pregnancies was 1.5 ± 1.2 in RAI patients vs. 1.9±1.1 in controls (P < 0.05). Most notably, infertility was observed in 23% (26/111) of RAI patients vs. 4% (4/90) of controls (P < 0.01). In conclusion, a international observational
case-control study on breast cancer after DTC in patients given RAI vs. not given RAI appears to be feasible. Additional research and everyday clinical attention should be devoted to reproductive function after RAI in young females.