Doi Suhail A R, Woodhouse Nicholas J Y
Endocrine Unit, Department of Medicine, Sultan Qaboos University Hospital, Al-Khod, Oman.
Clin Endocrinol (Oxf). 2000 Jun;52(6):765-773. doi: 10.1046/j.1365-2265.2000.01014.x.
To compare the efficacy of remnant ablation following a single low dose (specific activity of I administered, 1074-1110 MBq) vs. a single high dose (mostly 2775-3700 MBq) of I in patients with differentiated thyroid cancer and to determine whether or not the extent of surgery influences outcome.
Nineteen studies have reported the results of low dose I ablation. Of these, 11 met our criteria for a comparative analysis. Two additional cohorts of ours were added and these were analysed in two groups based on the extent of surgery (near-total [NT; Woodhouse1] vs. sub-total [ST; Woodhouse2]). There were 518 low dose and 449 high dose patients in all.
The average failure of a single low dose was 46 ± 28% (SD). Meta-analysis revealed a statistically significant advantage for a single high over a single low dose and a pooled reduction in relative risk of failure of the high dose of about 27% (P < 0.01). From this we estimate that for every seven patients treated one more would be ablated given a high rather than a low dose (assuming a low dose failure risk of 50%). Also, a significantly greater proportion of patients are ablated after a single high or low dose, if they underwent near-total as opposed to sub-total thyroidectomy (summary relative risk (RR) 1.4; P < 0.05).
High dose I is more efficient than low dose for remnant ablation particularly after less than total thyroidectomy. Results suggest that patients with differentiated thyroid cancer should routinely have a total thyroidectomy followed by high dose I (2775-3700MBq) for ablation of the remnant.
比较低剂量单次（给予的¹³¹I比活度为1074 - 1110MBq）与高剂量单次（大多为2775 - 3700MBq）¹³¹I对分化型甲状腺癌患者进行残留甲状腺组织消融的疗效，并确定手术范围是否会影响治疗结果。
19项研究报告了低剂量¹³¹I消融的结果。其中，11项符合我们进行比较分析的标准。我们又增加了另外两组队列，并根据手术范围（近全切除[NT；伍德豪斯1]与次全切除[ST；伍德豪斯2]）分为两组进行分析。总共纳入了518例低剂量患者和449例高剂量患者。
单次低剂量消融的平均失败率为46±28%（标准差）。荟萃分析显示，单次高剂量¹³¹I相对于单次低剂量具有统计学上的显著优势，高剂量组失败的相对风险总体降低约27%（P<0.01）。由此我们估计，假设低剂量失败风险为50%，每治疗7例患者，高剂量组比低剂量组多消融1例。此外，如果患者接受近全甲状腺切除术而非次全甲状腺切除术，那么单次高剂量或低剂量¹³¹I消融后被成功消融的患者比例显著更高（汇总相对风险（RR）为1.4；P<0.05）。
高剂量¹³¹I在残留甲状腺组织消融方面比低剂量更有效，尤其是在甲状腺未全切术后。结果表明，分化型甲状腺癌患者应常规进行全甲状腺切除术，然后给予高剂量¹³¹I（2775 - 3700MBq）进行残留甲状腺组织消融。
