Department of Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Road Building 16, Room 408E, Ann Arbor, Michigan 48109-2800, USA.
J Clin Endocrinol Metab. 2013 Feb;98(2):678-86. doi: 10.1210/jc.2012-3160. Epub 2013 Jan 15.
Although variation in radioactive iodine (RAI) use for thyroid cancer has been demonstrated, the role of region and nonclinical correlates of use within risk groups has not been investigated.
The objective of the study was to determine the correlates of RAI use within risk groups.
DESIGN/SETTING/PATIENTS: Use of RAI was evaluated across 9 US regions in 85 948 patients with well-differentiated thyroid cancer diagnosed between 2004 and 2008 at 986 hospitals associated with the US National Cancer Database. Cancers were then categorized as low risk (tumor size ≤ 1 cm and American Joint Committee on Cancer stage I disease), medium risk (neither low nor high-risk), and high risk (American Joint Committee on Cancer stage III or IV). Within each risk stratum, the role of region and nonclinical correlates of RAI use were evaluated using hierarchical logistic regression.
Use of RAI was measured.
Rates of RAI use varied across geographic regions from 49% to 66%. Regional differences persisted after controlling for patient and hospital characteristics and evaluating less vs more intensive regions within low-risk [odds ratio (OR) 0.36 (95% confidence interval [CI] 0.25-0.53)], medium-risk [OR 0.23 (95% CI 0.16-0.34)], and high-risk cancers [OR 0.30 (95% CI 0.19-0.49)]. Patterns of RAI use were similar in medium- and high-risk patients. The most nonclinical correlates of use were in low-risk patients.
Similar treatment patterns for the heterogeneous medium-risk thyroid cancer patients compared with the high-risk patients suggest more intensive management in patients with medium-risk disease. The large number of nonclinical correlates of RAI use, including region, imply controversy over indications for RAI.
尽管已经证明放射性碘（RAI）在甲状腺癌中的使用存在差异，但在风险组内，区域和非临床因素与使用的关系尚未得到研究。
本研究旨在确定风险组内 RAI 使用的相关因素。
设计/设置/患者：在美国国家癌症数据库（National Cancer Database）关联的 986 家医院中，对 85948 例 2004 年至 2008 年间确诊为分化型甲状腺癌的患者，评估了 9 个美国地区的 RAI 使用情况。然后，根据肿瘤大小（≤1cm 和美国癌症联合委员会分期 I 期）和美国癌症联合委员会分期（III 期或 IV 期），将癌症分为低危（low-risk）、中危（neither low nor high-risk）和高危（high-risk）。在每个风险分层内，使用分层逻辑回归评估区域和 RAI 使用的非临床相关因素的作用。
RAI 使用情况。
RAI 使用率在地理区域之间从 49%到 66%不等。在控制患者和医院特征并评估低危[比值比（OR）0.36（95%置信区间[CI]0.25-0.53）]、中危[OR 0.23（95% CI 0.16-0.34）]和高危癌症后，区域差异仍然存在，0.30（95% CI 0.19-0.49）]。中危和高危患者的 RAI 使用模式相似。低危患者使用的最主要的非临床相关因素。
与高危患者相比，中危甲状腺癌患者的治疗模式相似，这表明中危疾病患者的治疗更为积极。RAI 使用的大量非临床相关因素，包括区域因素，表明 RAI 的适应证存在争议。
