术后放射性碘与外照射治疗 IV 期分化型甲状腺癌的生存结局比较。

Comparison of Survival Outcomes Following Postsurgical Radioactive Iodine Versus External Beam Radiation in Stage IV Differentiated Thyroid Carcinoma.

机构信息

1 Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Shreveport , Shreveport, Louisiana.

2 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

出版信息

Thyroid. 2017 Jul;27(7):944-952. doi: 10.1089/thy.2016.0650. Epub 2017 May 17.

DOI:10.1089/thy.2016.0650

PMID:28446057

Abstract

BACKGROUND

There is a lack of well-powered data regarding outcomes in stage IV differentiated thyroid carcinoma (DTC) treated with postsurgical radiation. The objective of this study was to examine survival in patients with stage IV papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) who received radioactive iodine (RAI), external beam radiation therapy (EBRT), or neither following surgery.

METHODS

In this retrospective cohort study, data collected from the National Cancer Data Base (NCDB) yielded 11,832 patients with stage IV DTC who underwent primary surgical treatment between 2002 and 2012. Patients were stratified by histology and sub-stage. Fully parametric, multilevel survival-time models were used to evaluate survival outcomes in three adjuvant treatment groups: RAI, EBRT, or no adjuvant radiation. Hazard ratios (HR) and time ratios (TR) were calculated against patients who did not receive radiation. All models were adjusted for demographic and clinical factors.

RESULTS

The mean age of all patients was 61.6 years (SD = 11.6), and 57.5% were female. Patients who received EBRT had significantly higher 5- and 10-year hazards of death in several PTC sub-stages (10-year HR = 2.12 [confidence interval (CI) 1.79-2.52]; HR = 2.03 [CI 1.33-3.10]). For stage IV-B PTC requiring EBRT, lifespan after diagnosis was shortened by a factor of 3 when compared to patients who did not receive radiation (TR = 0.32 [CI 0.16-0.62]). In contrast, RAI was significantly associated with improved 5- and 10-year survival in both PTC and FTC patients regardless of pathological sub-stage. Large reductions in mortality were observed in patients with FTC who were treated with RAI (HR = 0.19 [CI 0.06-0.65]). When patients with stage IV-C FTC were treated with RAI, life-span after diagnosis doubled (TR = 1.98 [CI 1.31-3.00]).

CONCLUSIONS

Through the NCDB, this study sought to describe prognosis and survival for adjuvant radiation in stage IV DTC. RAI was associated with improved survival for stage IV DTC. Despite treatment benefits conferred by adjuvant EBRT, indications to treat with EBRT were associated with poorer survival outcomes in patients with advanced-stage DTC, particularly PTC.

摘要

背景

目前缺乏关于接受术后放射性碘（RAI）治疗的 IV 期分化型甲状腺癌（DTC）患者结局的充分数据。本研究的目的是研究术后接受 RAI、外照射放疗（EBRT）或两者均未接受的 IV 期甲状腺乳头状癌（PTC）和滤泡状甲状腺癌（FTC）患者的生存情况。

方法

本回顾性队列研究从国家癌症数据库（NCDB）中收集了 11832 例 2002 年至 2012 年间接受初始手术治疗的 IV 期 DTC 患者的数据。根据组织学和亚分期对患者进行分层。采用完全参数、多层次生存时间模型评估三组辅助治疗（RAI、EBRT 或无辅助放疗）的生存结局。与未接受放疗的患者相比，计算了危险比（HR）和时间比（TR）。所有模型均根据人口统计学和临床因素进行了调整。

结果

所有患者的平均年龄为 61.6 岁（SD=11.6），57.5%为女性。在几个 PTC 亚分期中，接受 EBRT 的患者 5 年和 10 年死亡风险显著升高（10 年 HR=2.12 [95%CI 1.79-2.52]；HR=2.03 [95%CI 1.33-3.10]）。对于需要 EBRT 的 IV-B 期 PTC，与未接受放疗的患者相比，诊断后的寿命缩短了 3 倍（TR=0.32 [95%CI 0.16-0.62]）。相比之下，RAI 与 PTC 和 FTC 患者的 5 年和 10 年生存率的提高显著相关，无论病理亚分期如何。FTC 患者接受 RAI 治疗可显著降低死亡率（HR=0.19 [95%CI 0.06-0.65]）。当 IV-C 期 FTC 患者接受 RAI 治疗时，诊断后的寿命增加了一倍（TR=1.98 [95%CI 1.31-3.00]）。