Claimon Apichaya, Pusuwan Pawana, Khiewvan Benjapa
J Med Assoc Thai. 2017 Feb;100(2):207-18.
Differentiated thyroid cancer (DTC) has a favorable prognosis following treatment by thyroidectomy and subsequent post-operative radioactive iodine therapy (RAIT). However, prognostic factors for the success of the first RAIT remain inconclusive. The aim of the present study was to evaluate prognostic factors for the success of the first RAIT in DTC patients.
We retrospectively studied 401 DTC patients who underwent total, near-total and subtotal thyroidectomy followed by high dose RAIT from 1994 to 2004. Successful RAIT was assessed using the following criteria: (a) stimulated serum thyroglobulin (sTg) < 10 ng/ml; (b) negative diagnostic 131I total body scan (DxTBS); and (c) no serial increase in thyroglobulin antibody (TgAb) levels. Factors influencing successful first RAIT were evaluated.
In total, 401 patients were enrolled into the present study. Most patients were female (81.5%) and had papillary cell type cancer (74.3%). Median tumor size was 2.55 cm. (range, 0–11 cm). Metastases at cervical node and distant sites were found prior to RAIT in 167 and 26 patients, respectively. The first RAIT doses of 2.96–3.7, 5.5 and 7.4 GBq were administered to 133, 262 and 6 patients, respectively. Overall success rate of the first RAIT was 32.9%. From univariate analysis, female sex, age of <45 years, underwent thyroidectomy without cervical lymph node dissection, no multifocality, free surgical margin, no metastasis and sTg of <20 ng/dl at ablation were prognostic factors. Age of <45 years and sTg of <20 ng/dl at ablation were independent significant prognostic factors (both p<0.001) from multivariate analysis.
Age below 45 years and sTg below 20 ng/dl at ablation are independent prognostic factors for the success of the first RAIT.
分化型甲状腺癌（DTC）在接受甲状腺切除术及随后的术后放射性碘治疗（RAIT）后预后良好。然而，首次RAIT成功的预后因素仍无定论。本研究的目的是评估DTC患者首次RAIT成功的预后因素。
我们回顾性研究了1994年至2004年间接受全甲状腺切除术、近全甲状腺切除术和次全甲状腺切除术并随后接受高剂量RAIT的401例DTC患者。采用以下标准评估RAIT是否成功：（a）刺激后血清甲状腺球蛋白（sTg）<10 ng/ml；（b）诊断性131I全身扫描（DxTBS）阴性；（c）甲状腺球蛋白抗体（TgAb）水平无连续升高。评估影响首次RAIT成功的因素。
本研究共纳入401例患者。大多数患者为女性（81.5%），且为乳头状细胞型癌（74.3%）。肿瘤中位大小为2.55 cm（范围0 - 11 cm）。分别有167例和26例患者在RAIT前发现颈部淋巴结转移和远处转移。首次RAIT剂量分别为2.96 - 3.7、5.5和7.4 GBq，分别给予133例、262例和6例患者。首次RAIT的总体成功率为32.9%。单因素分析显示，女性、年龄<45岁、未行颈部淋巴结清扫的甲状腺切除术、无多灶性、手术切缘阴性、无转移以及消融时sTg<20 ng/dl是预后因素。多因素分析显示，年龄<45岁和消融时sTg<20 ng/dl是独立的显著预后因素（均p<0.001）。
年龄低于45岁和消融时sTg低于20 ng/dl是首次RAIT成功的独立预后因素。
