Wang Renfei, Zhang Yueqian, Tan Jian, Zhang Guizhi, Zhang Ruiguo, Zheng Wei, He Yajing
Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Road, Tianjin, People's Republic of China.
Medicine (Baltimore). 2017 May;96(19):e6809. doi: 10.1097/MD.0000000000006809.
To assess the efficacy of radioiodine therapy (RIT) and investigate the prognostic factors for patients with pulmonary metastasis secondary to differentiated thyroid carcinoma (DTC) through a retrospective study. A total of 80 patients with radioactive iodine-131 (I)-avid pulmonary metastasis from DTC treated with I from 2007 to 2014 at our institution entered the study. Treatment response was mainly measured by two parameters: serum thyroglobulin (Tg) levels and post-therapeutic I whole-body scan (WBS). Treatment variables were assessed for statistical significance using the univariate and multivariate analyses. A receiver-operating characteristic (ROC) curve was also plotted to verify the accuracy of predictors. Of these 80 patients, the overall effective rate was 72.5% (58/80), the rates for complete response (CR), partial response (PR), and no response (NR) were 20.0%, 52.5%, and 27.5%, respectively. Univariate analysis showed that gender, pulmonary nodule size, absence or presence of extrapulmonary distant metastases, age, and Tg level at diagnosis were significantly associated with I therapy efficacy. Binary logistic regression analysis revealed that older patients (odds ratio [OR]:1.481, 95% confidence interval [CI]: 1.457-2.091, P = .020), subjects with higher Tg levels at diagnosis (OR: 1.046, 95% CI: 1.016-1.119, P = .014), and those with extrapulmonary distant metastases (OR: 1.185, 95%CI: 1.025-1.463, P = .020) had a higher probability of poor prognosis. The optimal cutoffs for age and Tg level to predict I therapy efficacy for DTC with lung metastases were 46 years old and 55.50 ng/mL, respectively, based on ROC analysis. This study indicated that most DTC patients with pulmonary metastases can obtain partial or complete remission after RIT, while older patients with higher Tg levels at diagnosis and extrapulmonary distant metastases more likely show poor prognosis.
通过一项回顾性研究评估放射性碘治疗（RIT）的疗效，并调查分化型甲状腺癌（DTC）肺转移患者的预后因素。2007年至2014年在我院接受碘-131（I）治疗的80例DTC肺转移且对放射性碘摄取阳性的患者纳入本研究。治疗反应主要通过两个参数衡量：血清甲状腺球蛋白（Tg）水平和治疗后I全身扫描（WBS）。使用单因素和多因素分析评估治疗变量的统计学意义。绘制受试者工作特征（ROC）曲线以验证预测指标的准确性。这80例患者中，总有效率为72.5%（58/80），完全缓解（CR）、部分缓解（PR）和无反应（NR）率分别为20.0%、52.5%和27.5%。单因素分析显示，性别、肺结节大小、有无肺外远处转移、年龄及诊断时的Tg水平与I治疗疗效显著相关。二元逻辑回归分析显示，年龄较大的患者（比值比[OR]：1.481，95%置信区间[CI]：I.457 - 2.091，P = 0.020）、诊断时Tg水平较高的患者（OR：1.046，95%CI：1.016 - 1.119，P = 0.014）以及有肺外远处转移的患者（OR：1.185，95%CI：1.025 - 1.463，P = 0.020）预后较差的可能性更高。基于ROC分析，预测DTC肺转移I治疗疗效的年龄和Tg水平的最佳截断值分别为46岁和55.50 ng/mL。本研究表明，大多数DTC肺转移患者在RIT后可获得部分或完全缓解，而诊断时Tg水平较高且有肺外远处转移的老年患者预后较差的可能性更大。
