低剂量和高剂量术后放射性碘治疗对伴有微小甲状腺外侵犯的小分化型甲状腺癌患者临床结局的影响。
Effects of low-dose and high-dose postoperative radioiodine therapy on the clinical outcome in patients with small differentiated thyroid cancer having microscopic extrathyroidal extension.
作者信息
Han Ji Min, Kim Won Gu, Kim Tae Yong, Jeon Min Ji, Ryu Jin-Sook, Song Dong Eun, Hong Suck Joon, Shong Young Kee, Kim Won Bae
机构信息
1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, South Korea .
出版信息
Thyroid. 2014 May;24(5):820-5. doi: 10.1089/thy.2013.0362. Epub 2014 Jan 29.
BACKGROUND
It is unclear whether differentiated thyroid cancer (DTC) patients classified as intermediate risk based on the presence of microscopic extrathyroidal extension (ETE) should be treated with low or high doses of radioiodine (RAI) after surgery. We evaluated success rates and long-term clinical outcomes of patients with DTC of small tumor size, microscopic ETE, and no cervical lymph node (LN) metastasis treated either with a low (1.1 GBq) or high RAI dose (5.5 GBq).
METHODS
This is a retrospective analysis of a historical cohort from 2000 to 2010 in a tertiary referral hospital. A total of 176 patients with small (≤2 cm) DTC, microscopic ETE, and no cervical LN metastasis were included. Ninety-six patients were treated with 1.1 GBq (LO group) and 80 patients with 5.5 GBq (HI group). Successful RAI therapy was defined as (i) negative stimulated thyroglobulin (Tg) in the absence of Tg antibodies, and (ii) absence of remnant thyroid tissue and of abnormal cervical LNs on ultrasonography. Clinical recurrence was defined as the reappearance of disease after ablation, which was confirmed by cytologically or pathologically proven malignant tissue or of distant metastatic lesions.
RESULTS
There was no significant difference in the rate of successful RAI therapy between the LO and HI groups (p=0.75). In a subgroup analysis based on tumor size, success rates were not different between the LO group (34/35, 97%) and the HI group (50/56, 89%) in patients with a tumor size of 1-2 cm (p=0.24). In patients with smaller tumor size (≤1 cm), there was no significant difference in success rates between the LO (59/61, 97%) and HI groups (22/24, 92%; p=0.30). No patient had clinical recurrences in either group during the median 7.2 years of follow-up.
CONCLUSIONS
Low-dose RAI therapy is sufficient to treat DTC patients classified as intermediate risk just by the presence of microscopic ETE.
背景
对于因存在微小甲状腺外侵犯（ETE）而被归类为中危的分化型甲状腺癌（DTC）患者，术后应采用低剂量还是高剂量放射性碘（RAI）治疗尚不清楚。我们评估了肿瘤体积小、存在微小ETE且无颈部淋巴结（LN）转移的DTC患者接受低剂量（1.1 GBq）或高剂量RAI（5.5 GBq）治疗的成功率和长期临床结局。
方法
这是一项对一家三级转诊医院2000年至2010年历史队列的回顾性分析。共纳入176例肿瘤体积小（≤2 cm）、存在微小ETE且无颈部LN转移的患者。96例患者接受1.1 GBq治疗（低剂量组），80例患者接受5.5 GBq治疗（高剂量组）。RAI治疗成功定义为：（i）在无Tg抗体的情况下，刺激后甲状腺球蛋白（Tg）阴性；（ii）超声检查无残余甲状腺组织及异常颈部LN。临床复发定义为消融后疾病再次出现，经细胞学或病理证实为恶性组织或远处转移病灶。
结果
低剂量组和高剂量组RAI治疗成功率无显著差异（p = 0.75）。在基于肿瘤大小的亚组分析中，肿瘤大小为1 - 2 cm的患者中，低剂量组（34/35，97%）和高剂量组（50/56，89%）的成功率无差异（p = 0.24）。对于肿瘤体积较小（≤1 cm）的患者，低剂量组（59/61，97%）和高剂量组（22/24，92%）的成功率无显著差异（p = 0.30）。在中位7.2年的随访期间，两组均无患者出现临床复发。
结论
低剂量RAI治疗足以治疗仅因存在微小ETE而被归类为中危的DTC患者。
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