不同剂量131I对中低危分化型甲状腺癌的疗效反应及预后分析

Therapy response and prognosis of different doses of 131I for low- and intermediate-risk differentiated thyroid carcinoma

摘要:

目的 探讨不同剂量¹³¹I对中低危分化型甲状腺癌（differentiated thyroid cancer，DTC）清除甲状腺组织（简称清甲）的疗效反应及无进展生存期（progression-free survival，PFS）有无差异。方法 回顾性分析201例¹³¹I清甲治疗的DTC患者，共236人次接受¹³¹I治疗。 根据治疗后6~12个月的血清学及影像学指标评估患者的疗效反应，根据¹³¹I治疗剂量分为1次1.1 GBq（G1组）、2次1.1 GBq（G2组）、3.0 GBq（G3组）和3.7 GBq（G4组）。对201例患者随访12~90个月，收集¹³¹I治疗后的血清学、影像学及治疗记录等资料，评估病情有无进展。卡方检验、Fisher确切概率法比较各治疗组的疗效差异及影响因素，Kaplan-Meier法及log-rank检验分析比较PFS，Cox比例风险模型评估PFS的独立预测因子。结果 ①4组的总疗效满意（excellent response，ER）、疗效不确切（indeterminate response，IDR）、血清学治疗反应不佳（biochemical incomplete response，BIR）和结构性治疗反应不佳（structural incomplete response，SIR）率分别为41.5%（98/236）、44.9%（106/236）、6.8%（16/236）及6.8%（16/236）。②4组的ER率分别为16.67%（10/60）、42.86%（15/35）、56.52%（13/23）及50.85%（60/118）；IDR率分别为60.00%（36/60）、45.71%（16/35）、30.43%（7/23）及39.83%（47/118）；BIR率分别为10.00%（6/60）、0.00%（0/35）、4.35%（1/23）及7.63%（9/118）；SIR率分别为13.33%（8/60）、11.43%（4/35）、8.70%（2/23）及1.69%（2/118）。③G1组与G2~G4组的清甲疗效满意度（ER率）及G1组与G4组结构性疗效不佳（SIR率）差异有统计学意义（P=0.005、0.000、0.000、0.003）。④中位随访30个月，病情进展患者18例（8.96%）。不同剂量组的PFS差异无统计学差异（P=0.112）。年龄和疗效反应与PFS显著相关。结论 对于中低危DTC患者，2次1.1 GBq与3.0 GBq及3.7 GBq ¹³¹I的短期清甲效果无明显差异；不同剂量清甲治疗与PFS无明显相关，年龄<55岁和¹³¹I治疗反应为ER的患者PFS更优。

Abstract:

Objective To investigate therapy response and progression-free survival（PFS） with different doses of ¹³¹I in postoperative patients with low- and intermediate-risk differentiated thyroid carcinoma（DTC）.Methods A total of 201 DTC patients with a total of 236 person-time ¹³¹I treatments with different doses of ¹³¹I were retrospectively analyzed. Serological and imaging indexes at 6 to 12 months after treatment were determined to evaluate the response of patients. And they were divided into four groups（G1 to G4 group） according to ¹³¹I administered activity（1.1 GBq once，1.1 GBq twice，3.0 GBq，3.7 GBq）. The patients were followed up for 12 to 90 months，and their serological， imaging and treatment records were collected after ¹³¹I therapy to assess the progression. Chi-square test and Fisher’s exact test were performed to compare the differences in efficacy response and influencing factors among the treatment groups. Kaplan-Meier method and log-rank test were used to compare the PFS. Cox proportional risk model was used to evaluate the independent risk factors for PFS.Results ①Total rate of excellent response（ER）/indeterminate response（IDR）/biochemical incomplete response（BIR）/structural incomplete response（SIR） among 4 groups were 41.5%（98/236），44.9%（106/236），6.8%（16/236） and 6.8%（16/236） respectively. ②The ER rates of G1 to G4 groups were 16.67%（10/60），42.86%（15/35），56.52%（13/23），and 50.85%（60/118）；the IDR rates of the four groups were 60.00% （36/60），45.71%（16/35），30.43%（7/23），and 39.83%（47/118）；the BIR rates of the four groups were 10.00%（6/60），0.00%（0/35），4.35%（1/23），and 7.63%（9/118）；the SIR rates of the four groups were 13.33%（8/60），11.43%（4/35），8.70%（2/23），and 1.69%（2/118） respectively. ③There was statistically significance in the rate of ER between G1 and G2/G3/G4（P=0.005；0.000；0.000） and SIR between G1 and G4（P=0.003）. ④The median follow-up time was 30 months，with progression observed in 18 patients（8.96%）. There were no significant differences in PFS among different doses of ¹³¹I（P=0.112）. Multivariate analysis showed that age and therapy response were independent prognostic factors for PFS.Conclusion The short-term ablation efficacy of ¹³¹I between multiple low-dose（1.1 GBq twice） group and high-dose（3.0 and 3.7 GBq） groups has no significant difference in postoperative patients with low- and intermediate-risk DTC. Different doses of ¹³¹I are not significantly related to PFS. For patients with ER and aged < 55 years，there is a PFS benefit.