Shengguang Yan, Ji-Eun Choi, Lijuan He Li
International Education Center, North China University of Science and Technology, Tangshan, Hebei, China (mainland).
Department of Education, Jeonju University, Jeonju-si, South Korea.
Med Sci Monit. 2016 Jul 13;22:2439-50. doi: 10.12659/msm.896535.
BACKGROUND The aim of this study was to compare the success rate of various levels of I-131 activity for use in remnant ablation in low-risk differentiated thyroid cancer. MATERIAL AND METHODS We identified eligible studies in 5 electronic databases up to December 2014 and the reference lists of original studies and review articles were hand searched for additional articles on this topic. Summary relative risks with their 95% confidence intervals were calculated with a random-effects model. Heterogeneity was assessed using I2 statistics. RESULTS Fourteen randomized clinical trials met the eligibility criteria. The data suggest that the pooled successful ablation rate is 5% lower (95% CI, 1-9% lower) when using 30 mCi compared with 100 mCi (test for heterogeneity, p=0.468, I2=0.0%). In stratified analysis, ablation success rates using 30 mCi are similar to 100 mCi in Asia (SRRs=0.91; 95%CI=0.72-1.14). However, the results favor 100 mCi in Europe (SRRs=0.95; 95%CI=0.91-0.99). Ablation success rates using 30 mCi are similar to 100 mCi in patients who underwent TT/NTT (total thyroidectomy/near total thyroidectomy) (SRRs=0.96; 95%CI=0.92-1.00) and TT/STT (SRRs=0.98; 95%CI=0.73-1.31). However, the result favor 100 mCi in patients who underwent ST/HT (subtotal thyroidectomy/ hemithyroidectomy) (SRRs=0.80; 95%CI=0.65-0.99). There was no publication bias in the present meta-analysis. CONCLUSIONS High radioiodine activity is better than low activity in terms of successful ablation rate in low-risk differentiated thyroid cancer, but the advantage of high activity seems to only exist in patients who underwent hemithyroidectomy/subtotal thyroidectomy, but not lymph node involvement, preparation before ablation, and definition of successful ablation.
背景 本研究的目的是比较不同剂量的I - 131用于低风险分化型甲状腺癌残留甲状腺组织消融的成功率。材料与方法 我们检索了截至2014年12月的5个电子数据库中的相关研究，并手动检索了原始研究和综述文章的参考文献列表以获取关于该主题的其他文章。采用随机效应模型计算汇总相对风险及其95%置信区间。使用I²统计量评估异质性。结果 14项随机临床试验符合纳入标准。数据表明，与使用100 mCi相比，使用30 mCi时汇总成功消融率低5%（95%CI，低1 - 9%）（异质性检验，p = 0.468，I² = 0.0%）。在分层分析中，亚洲使用30 mCi的消融成功率与100 mCi相似（SRRs = 0.91；95%CI = 0.72 - 1.14）。然而，欧洲的结果更倾向于100 mCi（SRRs = 0.95；95%CI = 0.91 - 0.99）。接受全甲状腺切除术/近全甲状腺切除术（TT/NTT）以及全甲状腺切除术/次全甲状腺切除术（TT/STT）的患者中，使用30 mCi的消融成功率与100 mCi相似（SRRs = 0.96；95%CI = 0.92 - 1.00）以及（SRRs = 0.98；95%CI = 0.73 - 1.31）。然而，接受次全甲状腺切除术/甲状腺半叶切除术（ST/HT）的患者结果更倾向于100 mCi（SRRs = 0.80；95%CI = 0.65 - 0.99）。本荟萃分析中不存在发表偏倚。结论 就低风险分化型甲状腺癌的成功消融率而言，高放射性碘活性优于低活性，但高活性的优势似乎仅存在于接受甲状腺半叶切除术/次全甲状腺切除术的患者中，而与淋巴结受累情况、消融前准备以及成功消融的定义无关。
