背景:放射性碘(RAI)治疗是甲状腺乳头状癌(PTC)患者甲状腺全切除术后的标准治疗方法。我们旨在确定中危和高危PTC患者对治疗反应的预测因素。此外,探讨了多种RAI治疗的影响.
方法:在一项为期3年的回顾性研究中,来自甲状腺全切除术后接受RAI治疗的中高危PTC患者的数据,在第一年和第三年结束时进行了分析。人口统计数据,肿瘤大小,囊/血管侵犯,甲状腺外延伸,局部或远处转移,RAI的初始剂量和累积剂量,血清甲状腺球蛋白(Tg),抗甲状腺球蛋白抗体(TgAb),和影像学检查结果进行了调查。对单一剂量RAI治疗有极好反应的患者,经过三年的随访,被归类为“响应者组”。优秀的反应被定义为刺激血清Tg小于1ng/ml,或未刺激的血清Tg低于0.2ng/ml的TgAb阴性患者的阴性影像学扫描。
结果:本研究分析了333份患者记录和完整的数据集。经过三年的初步治疗,271例患者为无应答者(NR),62例为应答者(R)。在基线,NR组的中位消融前血清Tg水平为5.7ng/ml,R组为1.25ng/ml(P<0.001)。TSH刺激的血清Tg大于15.7ng/ml,即使在多次RAI治疗后也与反应失败有关,AUC:0.717(0.660-0.774),灵敏度:52.5%,特异性:89.47%,P<0.001。另一方面,在16.2%的患者中,多次RAI治疗与优异的缓解相关.如果最初的术后超声成像证实存在局部区域受累,则ER的机会减少74%,或0.26,(95%CI:0.12-0.55),P<0.001。
结论:甲状腺全切除术后刺激的血清Tg和局部受累是中危和高危PTC患者对RAI治疗无反应的预测因素。此外,少数患者在多次RAI治疗后获得了优异的反应。
BACKGROUND: Radioactive iodine (RAI) therapy is the standard treatment approach after total thyroidectomy in patients with papillary thyroid carcinoma (PTC). We aimed to identify predictive factors of response to the treatment in intermediate and high-risk patients with PTC. In addition, the impact of multiple RAI treatments was explored.
METHODS: In a 3-year retrospective study, data from intermediate and high-risk patients with PTC who received RAI therapy following total thyroidectomy, were analyzed by the end of year-one and year-three. Demographic data, tumor size, capsular/vascular invasion, extrathyroidal extension, local or distant metastasis, initial dose and cumulative dose of RAI, serum
thyroglobulin(Tg), antithyroglobulin antibody(TgAb), and imaging findings were investigated. Patients with an excellent response to a single dose of RAI treatment, after three years of follow-up were classified as the \"Responder group\". Excellent response was defined as stimulated serum Tg less than 1 ng/ml, or unstimulated serum Tg less than 0.2 ng/ml in TgAb-negative patients with negative imaging scans.
RESULTS: 333 patient records with a complete data set were analyzed in this study. After three years of initial treatment, 271 patients were non-responders (NR) and 62 were responders (R). At baseline, the median pre-ablation serum Tg level was 5.7 ng/ml in the NR group, and 1.25 ng/ml in the R group (P < 0.001). TSH-Stimulated serum Tg greater than 15.7 ng/ml, was associated with response failure even after multiple RAI therapy, AUC: 0.717(0.660-0.774), sensitivity: 52.5%, specificity: 89.47%, P < 0.001. On the other hand, multiple RAI therapy was associated with excellent response in 16.2% of the patients. The chance of ER was decreased by 74% if initial post-operation ultrasound imaging confirmed the presence of locoregional involvement, OR 0.26, (95% CI: 0.12-0.55), P < 0.001.
CONCLUSIONS: Stimulated serum Tg and locoregional involvement after total thyroidectomy are predictive factors of non-response to RAI therapy in intermediate and high-risk patients with PTC. In addition, a minority of patients achieve excellent response after multiple RAI therapy.