放射性碘在甲状腺癌中的应用。
Use of radioactive iodine for thyroid cancer.
机构信息
Division of Metabolism, Endocrinology, and Diabetes, Department of Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
出版信息
JAMA. 2011 Aug 17;306(7):721-8. doi: 10.1001/jama.2011.1139.
CONTEXT
Substantial uncertainty persists about the indications for radioactive iodine for thyroid cancer. Use of radioactive iodine over time and the correlates of its use remain unknown.
OBJECTIVE
To determine practice patterns, the degree to which hospitals vary in their use of radioactive iodine, and factors that contribute to this variation.
DESIGN, SETTING, AND PATIENTS: Time trend analysis of radioactive iodine use in a cohort of 189,219 patients with well-differentiated thyroid cancer treated at 981 hospitals associated with the US National Cancer Database between 1990 and 2008. We used multilevel analysis to assess the correlates of patient and hospital characteristics on radioactive iodine use in the cohort treated from 2004 to 2008.
MAIN OUTCOME MEASURE
Use of radioactive iodine after total thyroidectomy.
RESULTS
Between 1990 and 2008, across all tumor sizes, there was a significant increase in the proportion of patients with well-differentiated thyroid cancer receiving radioactive iodine (1373/3397 [40.4%] vs 11,539/20,620 [56.0%]; P < .001). Multivariable analysis of patients treated from 2004 to 2008 found that there was a statistical difference in radioactive iodine use between American Joint Committee on Cancer stages I and IV (odds ratio [OR], 0.34; 95% confidence interval [CI], 0.31-0.37) but not between stages II/III and IV (for stage II vs stage IV, OR, 0.97; 95% CI, 0.88-1.07 and for stage III vs stage IV, OR, 1.06; 95% CI, 0.95-1.17). In addition to patient and tumor characteristics, hospital volume was associated with radioactive iodine use. Wide variation in radioactive iodine use existed, and only 21.1% of this variation was accounted for by patient and tumor characteristics. Hospital type and case volume accounted for 17.1% of the variation. After adjusting for available patient, tumor, and hospital characteristics, 29.1% of the variance was attributable to unexplained hospital characteristics.
CONCLUSION
Among patients treated for well-differentiated thyroid cancer at hospitals in the National Cancer Database, there was an increase in the proportion receiving radioactive iodine between 1990 and 2008; much of the variation in use was associated with hospital characteristics.
背景
放射性碘在甲状腺癌中的应用指征仍存在较大不确定性。放射性碘的使用时间及其使用相关因素尚不清楚。
目的
旨在确定实践模式，以及医院之间在放射性碘使用方面的差异程度，以及导致这种差异的因素。
设计、地点和患者：1990 年至 2008 年期间，在美国国家癌症数据库（National Cancer Database）相关的 981 家医院中，对 189219 例分化型甲状腺癌患者进行了队列时间趋势分析，评估了患者和医院特征与 2004 年至 2008 年期间接受治疗的患者放射性碘使用之间的相关性。我们使用多水平分析来评估患者和医院特征对接受治疗的患者放射性碘使用的相关性。
主要观察指标
全甲状腺切除术后放射性碘的使用。
结果
在所有肿瘤大小中，1990 年至 2008 年间，接受放射性碘治疗的分化型甲状腺癌患者比例显著增加（1373/3397[40.4%]vs 11539/20620[56.0%]；P<0.001）。对 2004 年至 2008 年期间接受治疗的患者进行多变量分析发现，美国癌症联合委员会（American Joint Committee on Cancer）分期 I 期和 IV 期之间放射性碘使用存在统计学差异（比值比[OR]，0.34；95%置信区间[CI]，0.31-0.37），但 II/III 期和 IV 期之间无统计学差异（与 IV 期相比，II 期 OR，0.97；95%CI，0.88-1.07；III 期 OR，1.06；95%CI，0.95-1.17）。除患者和肿瘤特征外，医院容量也与放射性碘的使用有关。放射性碘的使用存在广泛的差异，只有 21.1%的差异归因于患者和肿瘤特征。医院类型和病例量占差异的 17.1%。在调整了可用的患者、肿瘤和医院特征后，29.1%的方差归因于无法解释的医院特征。
结论
在国家癌症数据库的医院中接受分化型甲状腺癌治疗的患者中，1990 年至 2008 年间接受放射性碘治疗的比例有所增加；使用的差异很大程度上与医院特征有关。
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