甲状腺叶切除术联合放射性碘治疗在滤泡状甲状腺癌患者半甲状腺切除术后作为全甲状腺切除术的替代选择：长期随访。
Thyroid lobe ablation with radioactive iodine as an alternative to completion thyroidectomy after hemithyroidectomy in patients with follicular thyroid carcinoma: long-term follow-up.
机构信息
Thyroid Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
出版信息
Thyroid. 2012 Apr;22(4):369-76. doi: 10.1089/thy.2011.0198. Epub 2012 Mar 2.
BACKGROUND
Radioactive iodine lobe ablation (RAI-L-ABL) is a possible alternative to completion thyroidectomy (C-Tx) for follicular thyroid carcinoma (FTC), but no long-term outcome data are available after lobe ablation. We analyzed the long-term outcome of lobe ablation in a series of patients with FTC.
METHODS
This was a retrospective study of patients who were treated with lobe ablation between 1983 and 2008. Of 134 patients with FTC, 37 (27.6%) had lobe ablation with (131)I (30-32 mCi) (RAI-L-ABL), 68 (50.7%) had C-Tx, and 29 (21.6%) had initial total thyroidectomy (T-Tx). The main outcomes analyzed were (131)I uptake after lobe ablation, C-Tx or T-Tx, serum thyroglobulin (Tg), serum thyroid-stimulating hormone (TSH), long-term disease-specific mortality, and disease-free survival.
RESULTS
After lobe ablation, radioiodine uptake was significantly lower for the RAI-L-ABL group (0.6%) than for the C-Tx group (2.0%, p<0.005) or T-Tx group (1.3%, p=0.054). Subsequent remnant ablation was performed in 12 of 37 (32%) patients in the RAI-L-ABL group, in 58 of 68 (85.3%) patients in the C-Tx group, and in 25 of 29 (86.2%) patients in the T-Tx group (p<0.01). With median follow-up of 95 months for the RAI-L-ABL group, 47 months for the C-Tx group, and 53 months for the T-Tx group, there was one death in the RAI-L-ABL group and one death in the T-Tx group. No other RAI-L-ABL patients had detectable disease, whereas patients in the C-Tx group and two patients in the T-Tx group had detectable disease (p=0.18). Long-term stimulated or suppressed Tg of <1 ng/mL were found in 87.5% of the RAI-L-ABL group (n=28), 86.3% of the C-Tx group (n=57), and 77.8% of the T-Tx group (n=21). Tg was detectable in 40.6% of the RAI-L-ABL group compared to 13.8% of C-Tx and 28.6% of T-Tx groups (p<0.05, between groups).
CONCLUSIONS
RAI-L-ABL, C-Tx, and T-Tx are equally effective in achieving serum TSH concentrations of >25 mIU/L and preparing patients for conventional (131)I treatment and whole body scanning with similar long-term outcomes. However, persistent measurable Tg (range 0.2-2.2 ng/mL) is more common after RAI-L-ABL.
背景
放射性碘叶切除术（RAI-L-ABL）可能是滤泡状甲状腺癌（FTC）甲状腺全切术（C-Tx）的替代方案，但叶切除术后尚无长期结果数据。我们分析了一系列 FTC 患者行叶切除术后的长期结果。
方法
这是一项回顾性研究，纳入了 1983 年至 2008 年间接受叶切除术治疗的患者。在 134 例 FTC 患者中，37 例（27.6%）接受放射性碘叶切除术（131）I（30-32 mCi）（RAI-L-ABL），68 例（50.7%）接受 C-Tx，29 例（21.6%）接受初始甲状腺全切除术（T-Tx）。主要分析的结果包括叶切除术后 131I 摄取、C-Tx 或 T-Tx、血清甲状腺球蛋白（Tg）、血清促甲状腺激素（TSH）、疾病特异性死亡率和无病生存率。
结果
叶切除术后，RAI-L-ABL 组（0.6%）的放射性碘摄取明显低于 C-Tx 组（2.0%，p<0.005）或 T-Tx 组（1.3%，p=0.054）。随后，在 RAI-L-ABL 组的 12 例（32%）患者中进行了残余消融，在 C-Tx 组的 58 例（85.3%）患者中进行了残余消融，在 T-Tx 组的 25 例（86.2%）患者中进行了残余消融（p<0.01）。RAI-L-ABL 组的中位随访时间为 95 个月，C-Tx 组为 47 个月，T-Tx 组为 53 个月。在 RAI-L-ABL 组中有 1 例死亡，在 T-Tx 组中有 1 例死亡。RAI-L-ABL 组无患者发现疾病，而 C-Tx 组和 T-Tx 组各有 1 例患者发现疾病（p=0.18）。在 RAI-L-ABL 组中，87.5%（28 例）、C-Tx 组中 86.3%（57 例）和 T-Tx 组中 77.8%（21 例）的患者血清 Tg 刺激或抑制后<1ng/mL。RAI-L-ABL 组中有 40.6%的患者 Tg 可检测到，而 C-Tx 组为 13.8%，T-Tx 组为 28.6%（p<0.05，组间）。
结论
RAI-L-ABL、C-Tx 和 T-Tx 在实现血清 TSH 浓度>25 mIU/L 和使患者为常规（131）I 治疗和全身扫描做好准备方面同样有效，且长期结果相似。然而，RAI-L-ABL 后持续可检测到的 Tg（范围 0.2-2.2ng/mL）更为常见。
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