初始放射性碘治疗后甲状腺球蛋白和定量全身扫描对分化型甲状腺癌患者消融和临床反应的早期预测的预后意义。

Prognostic implication of thyroglobulin and quantified whole body scan after initial radioiodine therapy on early prediction of ablation and clinical response for the patients with differentiated thyroid cancer.

机构信息

Department of Nuclear Medicine, Korea Cancer Center Hospital, Seoul, Korea.

出版信息

Ann Nucl Med. 2012 Dec;26(10):777-86. doi: 10.1007/s12149-012-0640-1. Epub 2012 Aug 7.

DOI:10.1007/s12149-012-0640-1

PMID:22869417

Abstract

OBJECTIVE

To investigate predictors for successful ablation and disease-free status after high-dose radioiodine therapy in patients with differentiated thyroid cancer.

METHODS

We enrolled 173 consecutive patients with differentiated thyroid cancer between November 2001 and December 2004 retrospectively (female 145, 46 ± 12 years). All patients underwent total thyroidectomy and I-131 ablative therapy (IAT) (3.7-5.4 GBq). The success or failure of ablation was assessed 6-9 months after the IAT with reference to undetectable thyroglobulin (Tg) and negative I-131 whole body scan (WBS). Afterward, the decision for disease-free status was evaluated using Tg and WBS (follow-up period after 1st IAT 7-81 months, median 43 months, criteria of disease-free: less than 10 ng/ml TSH-stimulated Tg or less than 2 ng/ml TSH-unstimulated Tg and/or negative WBS). Clinical and tumoral factors such as sex, age, pathologic type, the size of tumor, quantified cervical uptake in WBS1, pattern in WBS1, ablative therapy dose, AJCC stage, lymph node (LN) stage, Tg just before IAT (Tg1), and ablation status were assessed using logistic regression analyses.

RESULTS

There were 93 successful ablations (54 %). Significant predictors for the ablation failure were Tg1 (OR = 8.42; 95 % CI = 2.76-25.69; p < 0.0001), LN metastasis (OR = 3.05; 95 % CI = 1.11-8.37; p = 0.031), and quantified cervical uptake in WBS1 (OR = 4.95; 95 % CI = 1.07-22.88; p = 0.041). One hundred fifty-five patients were determined as disease-free after follow-up. All the eighteen patients with persistent disease were identified as ablation failure after first IAT. Significant predictors for the disease-free status were Tg1 (OR = 0.98; 95 % CI = 0.97-0.99; p = 0.028), tumor size (OR = 0.53; 95 % CI = 0.28-0.96; p = 0.044), and quantified cervical uptake in WBS1 (OR = 0.87; 95 % CI = 0.76-0.98; p = 0.024).

CONCLUSIONS

The thyroglobulin and quantified cervical uptake in whole body scan are significant predictors for the successful ablation and disease-free status after follow-up.

摘要

目的

探讨影响分化型甲状腺癌患者大剂量碘-131 治疗后消融成功和无病生存状态的因素。

方法

回顾性分析 2001 年 11 月至 2004 年 12 月期间收治的 173 例分化型甲状腺癌患者的临床资料（女性 145 例，年龄 46 ± 12 岁）。所有患者均接受甲状腺全切除术和碘-131 消融治疗（IAT）（3.7-5.4GBq）。IAT 后 6-9 个月，根据甲状腺球蛋白（Tg）不可检测和碘-131 全身扫描（WBS）阴性评估消融的成功或失败。之后，根据 Tg 和 WBS 评估无病生存状态（第 1 次 IAT 后的随访时间为 7-81 个月，中位随访时间为 43 个月，无病状态的标准为 TSH 刺激后 Tg<10ng/ml 或 TSH 未刺激后 Tg<2ng/ml，以及 WBS 阴性）。采用逻辑回归分析评估性别、年龄、病理类型、肿瘤大小、WBS1 中颈区摄取量、WBS1 模式、消融治疗剂量、AJCC 分期、淋巴结（LN）分期、IAT 前 Tg1（Tg）和消融状态等临床和肿瘤因素。

结果

93 例（54%）患者消融成功。Tg1（OR=8.42；95%CI=2.76-25.69；p<0.0001）、LN 转移（OR=3.05；95%CI=1.11-8.37；p=0.031）和 WBS1 颈区摄取量（OR=4.95；95%CI=1.07-22.88；p=0.041）是消融失败的显著预测因素。155 例患者在随访后被确定为无病生存。所有 18 例持续存在疾病的患者均被确定为第 1 次 IAT 后消融失败。Tg1（OR=0.98；95%CI=0.97-0.99；p=0.028）、肿瘤大小（OR=0.53；95%CI=0.28-0.96；p=0.044）和 WBS1 颈区摄取量（OR=0.87；95%CI=0.76-0.98；p=0.024）是无病生存状态的显著预测因素。