甲状腺癌放射性碘治疗后的第二原发性恶性肿瘤风险：一项系统评价和荟萃分析。
Second primary malignancy risk after radioactive iodine treatment for thyroid cancer: a systematic review and meta-analysis.
作者信息
Sawka Anna M, Thabane Lehana, Parlea Luciana, Ibrahim-Zada Irada, Tsang Richard W, Brierley James D, Straus Sharon, Ezzat Shereen, Goldstein David P
机构信息
Division of Endocrinology and Department of Medicine, University Health Network, Toronto, Ontario, Canada.
出版信息
Thyroid. 2009 May;19(5):451-7. doi: 10.1089/thy.2008.0392.
BACKGROUND
The risk of second primary malignancies (SPMs) associated with cancer therapies is an important concern of thyroid cancer survivors and physicians. Our objective was to determine if the risk of SPMs is increased in individuals with thyroid cancer treated with radioactive iodine (RAI), compared to those not treated with RAI.
METHODS
We performed a systematic review of the literature and meta-analysis. Two independent reviewers screened citations and reviewed full-text papers. If not reported by the primary authors, the relative risk (RR) of SPMs was calculated by dividing the standardized incidence ratio of SPM in individuals with thyroid cancer treated with RAI compared to those not treated with RAI (with associated 95% confidence intervals [CI]). The natural logarithms of RRs of respective SPMs, weighted by the inverse of the variance, were pooled using fixed effects models and the exponential of the results was reported.
RESULTS
Two multi-center studies (one from Europe and the other from North America) were included in this review. The RR of SPMs in thyroid cancer survivors treated with RAI was significantly increased at 1.19 (95% confidence interval [CI] 1.04, 1.36, p = 0.010), relative to thyroid cancer survivors not treated with RAI (data from 16,502 individuals), using a minimum latency period of 2 to 3 years after thyroid cancer diagnosis. The RR of leukemia was also significantly increased in thyroid cancer survivors treated with RAI, with an RR of 2.5 (95% CI 1.13, 5.53, p = 0.024). We did not observe a significantly increased risk of the following cancers related to prior RAI treatment: bladder, breast, central nervous system, colon and rectum, digestive tract, stomach, pancreas, kidney (and renal pelvis), lung, or melanoma of skin.
CONCLUSIONS
The risk of SPMs in thyroid cancer survivors treated with RAI is slightly increased compared to thyroid cancer survivors not treated with RAI.
背景
与癌症治疗相关的第二原发性恶性肿瘤（SPM）风险是甲状腺癌幸存者和医生的重要关注点。我们的目的是确定与未接受放射性碘（RAI）治疗的甲状腺癌患者相比，接受RAI治疗的甲状腺癌患者发生SPM的风险是否增加。
方法
我们进行了文献系统综述和荟萃分析。两名独立审阅者筛选文献并审查全文论文。如果第一作者未报告，通过将接受RAI治疗的甲状腺癌患者与未接受RAI治疗的患者的SPM标准化发病率之比（及其相关的95%置信区间[CI]）相除来计算SPM的相对风险（RR）。使用固定效应模型汇总各SPM的RR的自然对数（以方差的倒数加权），并报告结果的指数。
结果
本综述纳入了两项多中心研究（一项来自欧洲，另一项来自北美）。与未接受RAI治疗的甲状腺癌幸存者（来自16,502人的数据）相比，接受RAI治疗的甲状腺癌幸存者发生SPM的RR显著增加，为1.19（95%置信区间[CI] 1.04，1.36，p = 0.010），甲状腺癌诊断后最短潜伏期为2至3年。接受RAI治疗的甲状腺癌幸存者患白血病的RR也显著增加，为2.5（95% CI 1.13，5.53，p = 0.024）。我们未观察到与先前RAI治疗相关的以下癌症风险显著增加：膀胱癌、乳腺癌、中枢神经系统癌、结肠直肠癌、消化道癌、胃癌、胰腺癌、肾癌（和肾盂）、肺癌或皮肤黑色素瘤。
结论
与未接受RAI治疗的甲状腺癌幸存者相比，接受RAI治疗的甲状腺癌幸存者发生SPM的风险略有增加。
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