分化型甲状腺癌患者的第二原发癌：碘 131 治疗是否起作用？

Second Primary Cancer in Patients with Differentiated Thyroid Cancer: Does Radioiodine Play a Role?

机构信息

1 Department of Endocrinology, Portuguese Institute of Oncology , Lisbon Center, Lisbon, Portugal .

2 Department of Nuclear Medicine, Portuguese Institute of Oncology , Lisbon Center, Lisbon, Portugal .

出版信息

Thyroid. 2017 Aug;27(8):1068-1076. doi: 10.1089/thy.2016.0655. Epub 2017 Jul 14.

DOI:10.1089/thy.2016.0655

PMID:28614983

Abstract

BACKGROUND

Well-differentiated thyroid cancer (WDTC) is the most common endocrine neoplasia, and its incidence is rising. Studies have reported an increased risk of second primary cancer (SPC) in WDTC survivors, but its relationship with radioiodine treatment (RAIT) and other risk factors remains controversial. This study evaluated whether RAIT is an independent risk factor for SPC in WDTC patients.

METHODS

This was a retrospective single-center study. A total of 2031 patients with WDTC diagnosed between 1998 and 2009, treated and followed at the authors' tertiary cancer center, were included.

RESULTS

The median age of patients was 48 years (range 5-90 years); 83% were women and 77% underwent RAIT. The median follow-up was 8.8 years (range 5.0-17.0 years). A total of 130 SPC were diagnosed: 108/1570 (6.9%) received RAIT (RAIT+) and 22/461 (4.8%) did not (RAIT-). The most common SPC was breast cancer (31%), followed by genitourinary and gastrointestinal cancer (18% each). The 10-year cumulative incidence of SPC was 8.2% in RAIT+ and 4.5% in RAIT-. The absolute risk increase in the RAIT+ group versus the RAIT- group at 10 years of follow-up was 0.039 [confidence interval (CI) 0.011-0.067] per patient-year. The number needed to harm (NNH) was 25.6 [CI 15.0-87.2], indicating that on average during a 10-year follow-up period, there is one additional case of SPC for every 26 patients receiving RAIT. When controlling for age, sex, and familial and personal histories of cancer, there was an 84% increase in the risk of SPC in the RAIT+ group compared to the RAIT- group (p = 0.026; relative risk = 1.84 [CI 1.02-3.31]). There was an association between SPC incidence and total cumulative activity administered, which was statistically significant >200 mCi. The incidence of SPC was higher in both the WDCT and the RAIT+ cohorts compared to the general population (standardized incidence ratios = 1.32 and 1.40, respectively).

CONCLUSION

These results indicate that in spite of the low incidence of SPC in WDTC patients, the risk is increased after RAIT, particularly for activities >200 mCi. Thus, considering the excellent survival of patients with WDTC, clinicians need to weigh the risks and benefits of RAIT, especially in patients with low-risk thyroid cancer.

摘要

背景

分化型甲状腺癌（WDTC）是最常见的内分泌肿瘤，其发病率正在上升。研究报告称 WDTC 幸存者发生第二原发癌（SPC）的风险增加，但放射性碘治疗（RAIT）与其他危险因素之间的关系仍存在争议。本研究评估了 RAIT 是否是 WDTC 患者 SPC 的独立危险因素。

方法

这是一项回顾性单中心研究。共纳入 1998 年至 2009 年间在作者所在的三级癌症中心诊断并接受治疗和随访的 2031 例 WDTC 患者。

结果

患者的中位年龄为 48 岁（5-90 岁）；83%为女性，77%接受了 RAIT。中位随访时间为 8.8 年（5.0-17.0 年）。共诊断出 130 例 SPC：108/1570 例（6.9%）接受了 RAIT（RAIT+），22/461 例（4.8%）未接受 RAIT（RAIT-）。最常见的 SPC 是乳腺癌（31%），其次是泌尿生殖系统和胃肠道癌症（各 18%）。RAIT+组和 RAIT-组的 10 年累积 SPC 发生率分别为 8.2%和 4.5%。RAIT+组与 RAIT-组在 10 年随访中 SPC 风险增加的绝对风险增加为 0.039[置信区间（CI）0.011-0.067]每患者-年。危害人数（NNH）为 25.6[CI 15.0-87.2]，这表明在平均 10 年随访期间，每接受 RAIT 的 26 例患者中就会额外出现 1 例 SPC。在控制年龄、性别以及家族和个人癌症史后，RAIT+组发生 SPC 的风险比 RAIT-组增加了 84%（p=0.026；相对风险=1.84[CI 1.02-3.31]）。SPC 发生率与给予的总累积活性之间存在关联，且具有统计学意义（>200 mCi）。WDCT 和 RAIT+两组的 SPC 发生率均高于普通人群（标准化发病比分别为 1.32 和 1.40）。