应用~(131)I化疗不同年龄背景下分化型甲状腺癌患者术后治疗疗效及预后评估
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摘要
目的通过分析术后~(131)I治疗对不同年龄背景下DTC患者的治疗疗效及预后,评估术后~(131)I治疗的价值。方法患者分为少年、青年、中年及老年组,甲状腺切除术后行~(131)I治疗,依据肺部CT扫描、血清TSH水平及Tg水平确定患者是否需要接受多次~(131)I治疗。分析患者二次治疗后的临床转归结果以及多次治疗成功后的生存率。结果少年及老年组患者淋巴结转移率、肺转移率及~(131)I二次治疗比例均高于中、青年组。临床转归情况、~(131)I二次治疗效果及平均治疗次数组间比较差异显著。肺转移患者治疗有效率与无肺转移患者相比差异显著。~(131)I多次治疗后复发率组间比较差异不显著,无进展累积生存差异不显著。结论相较于中、青年DTC患者,少年及老年患者更易发生淋巴结转移及肺转移,二次治疗临床转归效果也较低,复发率高。然而多次治疗至血清Tg水平转阴后的远期无进展生存情况无显著性差异。因此DTC术后~(131)I多次治疗对不同年龄背景的患者都是有效的治疗手段。
Objective To evaluate the therapeutic efficacy and prognosis of postoperative~(131)I in patients with DTC under different age backgrounds and evaluate the value of postoperative~(131)I treatment. Methods The patients were divided into adolescents,youth,middle-aged and elderly patients. The~(131)I treatments were performed after thyroidectomy. According to the CT scan of the lungs,serum TSH levels and Tg levels,patients were treated with~(131)I for several times. The clinical outcome after secondary treatment and the survival rate after multiple treatments were analyzed. Results The lymph node metastasis rate,pulmonary metastasis rate and the proportion of~(131)I second treatment in adolescent and elderly patients were higher than those in middle and young patients. Clinical outcomes,~(131)I secondary treatment and the average number of treatment was significantly different between the groups. There was a significant difference in the treatment response between patients with lung metastases and those without lung metastases. The recurrence rate of~(131)I after multiple treatments was not significantly different between the two groups,and the cumulative progression-free survival was not significant. Conclusion Compared with young and middle-aged patients with DTC,juvenile and elderly patients are more prone to lymph node metastasis and lung metastases. The second treatment of clinical outcome is less effective and the higher recurrence rate. However,there was no significant difference in long-term progression-free survival after repeated treatment until serum Tg turned negative. Therefore,~(131)I after DTC multiple treatment of patients of different age backgrounds are effective treatment.
Objective To evaluate the therapeutic efficacy and prognosis of postoperative~(131)I in patients with DTC under different age backgrounds and evaluate the value of postoperative~(131)I treatment. Methods The patients were divided into adolescents,youth,middle-aged and elderly patients. The~(131)I treatments were performed after thyroidectomy. According to the CT scan of the lungs,serum TSH levels and Tg levels,patients were treated with~(131)I for several times. The clinical outcome after secondary treatment and the survival rate after multiple treatments were analyzed. Results The lymph node metastasis rate,pulmonary metastasis rate and the proportion of~(131)I second treatment in adolescent and elderly patients were higher than those in middle and young patients. Clinical outcomes,~(131)I secondary treatment and the average number of treatment was significantly different between the groups. There was a significant difference in the treatment response between patients with lung metastases and those without lung metastases. The recurrence rate of~(131)I after multiple treatments was not significantly different between the two groups,and the cumulative progression-free survival was not significant. Conclusion Compared with young and middle-aged patients with DTC,juvenile and elderly patients are more prone to lymph node metastasis and lung metastases. The second treatment of clinical outcome is less effective and the higher recurrence rate. However,there was no significant difference in long-term progression-free survival after repeated treatment until serum Tg turned negative. Therefore,~(131)I after DTC multiple treatment of patients of different age backgrounds are effective treatment.
引文
[1]夏非,华清泉.颈部微小切口腔镜治疗甲状腺腺瘤疗效评价及术后凝血障碍发生的影响因素分析[J].中南医学科学杂志,2017(5):492-495.
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[7]王宸,赵腾,李娇,等.分化型甲状腺癌肺转移131I治疗后早期Tg变化与远期临床转归的关系[J].中华核医学与分子影像杂志,2017,37(9):555-558.
[8]杨晓明,张雪辉,陆名义,等.甲状腺癌131I清甲治疗前后Tg及Tg Ab测定值分析[J].肿瘤学杂志,2017,23(4):286-289.
[9]陈志丹,陈德杰.甲状腺癌术后复发相关危险因素分析及复发预测模型构建[J].东南大学学报(医学版),2015(1):92-95.
[10]刘良森,韦智晓,李俊红,等.老年分化型甲状腺癌肺转移危险因素分析[J].标记免疫分析与临床,2016,23(5):495-497.
[11]Garg A,Chopra S,Ballal S,et al.Differentiated thyroid cancer in patients over 60 years of age at presentation:a retrospective study of 438 patients[J].J Geriatr Oncol,2015,6(1):29-37.
[12]侯卫科.TGSF和Tg联合检测甲状腺癌的诊断价值[J].检验医学与临床,2017,14(6):879-880.
[2]朱郧鹤,骆磊,孙鹏,等.131I剂量差异对根治术后中低危甲状腺癌患者清甲成功率及反应效果的影响[J].标记免疫分析与临床,2017,24(5):526-529.
[3]弓彦伟,刘静.分化型甲状腺癌术后首次不同剂量131I清除残留甲状腺组织的临床观察[J].实用癌症杂志,2017,32(1):147-149.
[4]SH Son,SW Lee,JH Jung,et al.Analysis of Clinical Factors for the Determination of Optimal Serum Level of Thyrotropin After Recombinant Human Thyroid-Stimulating Hormone Administration[J].Nuclear Medicine&Molecular Imaging,2015,49(4):268-275.
[5]田文,郗洪庆.甲状腺癌病人生存现状分析[J].中国实用外科杂志,2016,36(5):489-493.
[6]赵腾,梁军,李田军,等.分化型甲状腺癌131I治疗前刺激性Tg动态变化与远处转移的关系[J].中国医学科学院学报,2015,37(3):315-319.
[7]王宸,赵腾,李娇,等.分化型甲状腺癌肺转移131I治疗后早期Tg变化与远期临床转归的关系[J].中华核医学与分子影像杂志,2017,37(9):555-558.
[8]杨晓明,张雪辉,陆名义,等.甲状腺癌131I清甲治疗前后Tg及Tg Ab测定值分析[J].肿瘤学杂志,2017,23(4):286-289.
[9]陈志丹,陈德杰.甲状腺癌术后复发相关危险因素分析及复发预测模型构建[J].东南大学学报(医学版),2015(1):92-95.
[10]刘良森,韦智晓,李俊红,等.老年分化型甲状腺癌肺转移危险因素分析[J].标记免疫分析与临床,2016,23(5):495-497.
[11]Garg A,Chopra S,Ballal S,et al.Differentiated thyroid cancer in patients over 60 years of age at presentation:a retrospective study of 438 patients[J].J Geriatr Oncol,2015,6(1):29-37.
[12]侯卫科.TGSF和Tg联合检测甲状腺癌的诊断价值[J].检验医学与临床,2017,14(6):879-880.