目的:放射性碘(RAI)治疗中危甲状腺乳头状癌(PTC)的应用仍是一个持续讨论的话题。本系统评价和荟萃分析旨在巩固现有证据,证明术后RAI治疗对中危PTC复发和生存结局的影响。
方法:使用PubMed中的相关关键词进行了文献检索,Scopus,和EMBASE。包括2008年1月至2023年3月的文章。赔率比(ORs)和危险比(HRs)从单个文章中提取,并使用荟萃分析生成汇总估计值。
结果:共纳入11篇文章,包括56,266例中危PTC患者。41,530例(73.8%)患者接受了术后RAI治疗,14,736例(26.2%)患者接受了无RAI(NOI)随访。与NOI随访相比,RAI治疗未发现结构性疾病复发率显着降低(合并单变量OR,0.73,95%置信区间[CI],0.29-1.87,I2=75%)。RAI治疗不是更好的无复发生存率的显著预测因子(合并的多变量HR,0.21;95%CI,0.01-3.74,I2=94%)。有趣的是,与NOI随访相比,RAI治疗与总体生存获益相关(合并多变量HR,0.63;95%CI,0.48-0.82,I2=79%)。
结论:这项荟萃分析并未确定RAI治疗在预防结构性疾病复发或改善中危PTC无复发生存率方面的决定性益处。然而,由于现有文献的显著异质性,这些结果需要谨慎解释.一个潜在的,随机临床试验需要一个小时来更好地了解RAI治疗对长期结局的影响.
The utility of radioiodine (RAI) therapy in intermediate-risk papillary thyroid carcinoma (PTC) remains a topic of ongoing discussion. This systematic review and meta-analysis aimed to consolidate existing evidence on the impact of postoperative RAI therapy on recurrence and survival outcomes in intermediate-risk PTC.
A literature search was performed using relevant keywords in PubMed, Scopus, and EMBASE. Articles from January 2008 to March 2023 were included. Odds ratios (ORs) and hazard ratios (HRs) were extracted from the individual articles, and pooled estimates were generated using meta-analysis.
Eleven articles comprising 56,266 intermediate-risk PTC patients were included. 41,530 (73.8%) patients underwent postoperative RAI therapy, while 14,736 (26.2%) patients were kept on no-RAI (NOI) follow-up. No significant reduction in rates of structural disease recurrence was noted with RAI therapy in comparison to NOI follow-up (pooled univariate OR, 0.73, 95% confidence interval [CI], 0.29-1.87, I2 = 75%). RAI therapy was not a significant predictor of better recurrence-free survival (pooled multivariate HR, 0.21; 95% CI, 0.01-3.74, I2 = 94%). Interestingly, RAI therapy was associated with an overall survival benefit compared to NOI follow-up (pooled multivariate HR, 0.63; 95% CI, 0.48-0.82, I2 = 79%).
This meta-analysis did not establish a conclusive benefit of RAI therapy in preventing structural disease recurrence or improving recurrence-free survival in intermediate-risk PTC. However, these results need to be interpreted with caution owing to significant heterogeneity in the existing literature. A prospective, randomised clinical trial is the need of the hour to better understand the effect of RAI therapy on long-term outcomes.