辅助放射性碘治疗与中危乳头状甲状腺癌患者的生存率提高相关。
Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer.
作者信息
Ruel Ewa, Thomas Samantha, Dinan Michaela, Perkins Jennifer M, Roman Sanziana A, Sosa Julie Ann
机构信息
Department of Medicine (E.R., J.M.P.), Division of Endocrinology, Metabolism, and Nutrition, Department of Surgery (J.A.S.), Section of Endocrine Surgery, Duke University Medical Center, and Duke Cancer Institute (J.A.S.), Durham, North Carolina 27710; Department of Biostatistics (S.T.), Duke University, Durham, North Carolina 27708; and Duke Clinical Research Institute (M.D., J.A.S.), Durham, North Carolina 27705.
出版信息
J Clin Endocrinol Metab. 2015 Apr;100(4):1529-36. doi: 10.1210/jc.2014-4332. Epub 2015 Feb 2.
CONTEXT
Papillary thyroid cancer (PTC) is the most common endocrine malignancy. The long-term prognosis is generally excellent. Due to a paucity of data, debate exists regarding the benefit of adjuvant radioactive iodine therapy (RAI) for intermediate-risk patients.
OBJECTIVE
The objective of the study was to examine the impact of RAI on overall survival in intermediate-risk PTC patients.
DESIGN/SETTING: Adult patients with intermediate-risk PTC who underwent total thyroidectomy with/without RAI in the National Cancer Database, 1998-2006, participated in the study.
PATIENTS
Intermediate-risk patients, as defined by American Thyroid Association risk and American Joint Commission on Cancer disease stage T3, N0, M0 or Mx, and T1-3, N1, M0, or Mx were included in the study. Patients with aggressive variants and multiple primaries were excluded.
MAIN OUTCOME MEASURES
Overall survival (OS) for patients treated with and without RAI using univariate and multivariate regression analyses was measured.
RESULTS
A total of 21 870 patients were included; 15 418 (70.5%) received RAI and 6452 (29.5%) did not. Mean follow-up was 6 years, with the longest follow-up of 14 years. In an unadjusted analysis, RAI was associated with improved OS in all patients (P < .001) as well as in a subgroup analysis among patients younger than 45 years (n = 12 612, P = .002) and 65 years old and older (median OS 140 vs 128 mo, n = 2122, P = .008). After a multivariate adjustment for demographic and clinical factors, RAI was associated with a 29% reduction in the risk of death, with a hazard risk 0.71 (95% confidence interval 0.62-0.82, P < .001). For age younger than 45 years, RAI was associated with a 36% reduction in risk of death, with a hazard risk 0.64 (95% confidence interval 0.45- 0.92, P = .016).
CONCLUSION
This is the first nationally representative study of intermediate-risk PTC patients and RAI therapy demonstrating an association of RAI with improved overall survival. We recommend that this patient group should be considered for RAI therapy.
背景
甲状腺乳头状癌（PTC）是最常见的内分泌恶性肿瘤。其长期预后通常较好。由于数据有限，关于辅助放射性碘治疗（RAI）对中危患者的益处存在争议。
目的
本研究的目的是探讨RAI对中危PTC患者总生存期的影响。
设计/研究地点：1998 - 2006年美国国家癌症数据库中接受甲状腺全切术且接受或未接受RAI治疗的成年中危PTC患者参与了本研究。
患者
纳入的中危患者定义为美国甲状腺协会风险评估以及美国癌症联合委员会疾病分期为T3、N0、M0或Mx，以及T1 - 3、N1、M0或Mx的患者。具有侵袭性变异和多原发性肿瘤的患者被排除。
主要观察指标
采用单因素和多因素回归分析测量接受和未接受RAI治疗患者的总生存期（OS）。
结果
共纳入21870例患者；15418例（70.5%）接受了RAI治疗，6452例（29.5%）未接受。平均随访6年，最长随访14年。在未经调整的分析中，RAI与所有患者的OS改善相关（P < .001），在年龄小于45岁的亚组分析中（n = 12612，P = .002）以及65岁及以上的亚组分析中（中位OS 140个月对128个月，n = 2122，P = .008）也相关。在对人口统计学和临床因素进行多因素调整后，RAI与死亡风险降低29%相关，风险比为0.71（95%置信区间0.62 - 0.82，P < .001）。对于年龄小于45岁的患者，RAI与死亡风险降低36%相关，风险比为0.64（95%置信区间0.45 - 0.92，P = .016）。
结论
这是第一项关于中危PTC患者和RAI治疗的具有全国代表性的研究，证明了RAI与总生存期改善之间的关联。我们建议应考虑对该患者群体进行RAI治疗。
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