131I 治疗分化型甲状腺癌骨转移的疗效及生存分析。
Efficacy and survival analysis of 131I therapy for bone metastases from differentiated thyroid cancer.
机构信息
Department of Nuclear Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, People's Republic of China.
出版信息
J Clin Endocrinol Metab. 2011 Oct;96(10):3078-86. doi: 10.1210/jc.2011-0093. Epub 2011 Jul 27.
OBJECTIVE
Our objective was to investigate the clinical efficacy of (131)I therapy for bone metastases from differentiated thyroid cancer (DTC) and prognostic factors as well as to assess patient survival and variables influencing survival.
METHODS
One hundred six DTC patients with bone metastases treated with (131)I were retrospectively analyzed. The therapeutic efficacy was evaluated based on the change in serum thyroglobulin (Tg), the palliation of bone pain, and the anatomical imaging changes in bone lesions. The overall survival rates were estimated using the life-table method.
RESULTS
After (131)I therapy, a significant decrease in serum Tg was seen in 37 cases (34.9%), and serum Tg remained stable in 56 patients (52.8%). Among the 61 patients with painful bone metastases, 39 patients obtained a significant relief of bone pain, and the effective rate was 63.9%. The majority of DTC patients (76.4%) exhibited no obvious anatomical imaging changes in metastatic bone lesions after (131)I therapy. Only histopathological type and whether combined with nonosseous distant metastases had statistically significant impacts on changes in serum Tg (P = 0.009 and 0.023), and age over 45 yr and papillary thyroid carcinoma had favorable response on changes in anatomical imaging (P = 0.027 and 0.014). The 5- and 10-yr survival rates were 86.5 and 57.9%, respectively. Multivariate analyses showed that the presence of solitary bone metastases, only bone metastases, and (131)I therapy with previous bone surgery were independent factors associated with a better prognosis (P = 0.024, 0.009, and 0.031).
CONCLUSION
(131)I therapy is a feasible and effective treatment for DTC bone metastases. A better prognosis can be accomplished in patients who had a single metastatic lesion, only bone metastasis, or underwent bone surgery before (131)I therapy.
目的
本研究旨在探讨碘-131（131I）治疗分化型甲状腺癌（DTC）骨转移的临床疗效及预后因素，评估患者的生存情况及影响生存的变量。
方法
回顾性分析 106 例接受 131I 治疗的 DTC 骨转移患者。根据血清甲状腺球蛋白（Tg）的变化、骨痛缓解情况和骨病灶的解剖影像学变化来评估治疗效果。采用寿命表法估计总生存率。
结果
131I 治疗后，37 例（34.9%）患者血清 Tg 明显下降，56 例（52.8%）患者血清 Tg 稳定。在 61 例有骨痛的患者中，39 例骨痛明显缓解，有效率为 63.9%。大多数 DTC 患者（76.4%）在 131I 治疗后转移性骨病变的解剖影像学无明显变化。仅组织病理学类型和是否合并非骨远处转移对血清 Tg 的变化有统计学意义（P=0.009 和 0.023），年龄>45 岁和甲状腺乳头状癌对解剖影像学的变化有良好的反应（P=0.027 和 0.014）。5 年和 10 年生存率分别为 86.5%和 57.9%。多因素分析显示，单发骨转移、仅骨转移和（131）I 治疗前有骨手术是与预后较好相关的独立因素（P=0.024、0.009 和 0.031）。
结论
131I 治疗是 DTC 骨转移的一种可行且有效的治疗方法。对于单发转移灶、仅骨转移或（131）I 治疗前有骨手术的患者，预后较好。
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