低风险分化型甲状腺癌患者的低剂量放射性碘消融治疗
Low-Dose Radioiodine Ablation in Patients with Low-Risk Differentiated Thyroid Cancer.
作者信息
Jimenez Londoño Germán A, Garcia Vicente Ana Maria, Sastre Marcos Julia, Pena Pardo Francisco Jose, Amo-Salas Mariano, Moreno Caballero Manuel, Talavera Rubio Maria Prado, Gonzalez Garcia Beatriz, Disotuar Ruiz Niletys Dafne, Soriano Castrejón Angel Maria
机构信息
Nuclear Medicine Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
Department of Endocrinology, Complejo Hospitalario de Toledo, Toledo, Spain.
出版信息
Eur Thyroid J. 2018 Aug;7(4):218-224. doi: 10.1159/000489850. Epub 2018 Jul 5.
AIM
Based on the response criteria of the 2015 American Thyroid Associations guidelines, our objectives were to -determine the response rate when using a low dose of -131-I GBq in patients with low-risk differentiated thyroid cancer (LRDTC) and the influence of clinical and analytical variables on the prediction of complete response.
METHODS
We performed a multicentre and longitudinal study, including patients who were operated for LRDTC and who underwent radioiodine remnant ablation with a low-dose of 131-I. All patients were assessed at 6-12 months, and their status was classified as complete (excellent response) or incomplete response (structural incomplete, biochemical incomplete or indeterminate response). Various factors including age, gender, histology, tumour focality and size, stage, time from surgery to treatment, type of thyroid-stimulating hormone (TSH) stimulation, preablation serum thyroglobulin (pTg), antiTg antibodies (pAntiTgAb) and TSH (pTSH) levels were also analysed in order to predict the complete response rate.
RESULTS
Of 108 patients, 79.6$ achieved complete response and the remaining showed incomplete response (2.9, 5.5 and 12$ due to biochemical incomplete, structural incomplete and indeterminate response respectively). Six patients received a new dose of 131-I. Tumour size and pAntiTgAb were the only factors related to therapeutic response ( = 0.03 and < 0.01, respectively). However, pAntiTgAb was the only independent factor related to complete -response. Patients with complete response showed lower pTg than those with incomplete response (5.1 ± 12.9 vs. 11.2 ± 25 ng/mL) although without statistical significance ( = 0.14). There was no significant difference in the response rate depending on the thyrotropin stimulation methods.
CONCLUSIONS
A low dose of 131-I was sufficient for reaching a complete response at 6-12 months of follow-up in the majority of patients with LRDTC. Tumour size and pAntiTgAb variables were related to therapeutic response.
目的
根据2015年美国甲状腺协会指南的反应标准，我们的目标是确定低风险分化型甲状腺癌（LRDTC）患者使用低剂量131碘（131-I）时的缓解率，以及临床和分析变量对完全缓解预测的影响。
方法
我们进行了一项多中心纵向研究，纳入接受LRDTC手术且接受低剂量131-I放射性碘残留消融的患者。所有患者在6至12个月时接受评估，其状态分为完全缓解（极佳反应）或不完全缓解（结构不完全、生化不完全或不确定反应）。还分析了包括年龄、性别、组织学、肿瘤灶性和大小、分期、手术至治疗的时间、促甲状腺激素（TSH）刺激类型、消融前血清甲状腺球蛋白（pTg）、抗甲状腺球蛋白抗体（pAntiTgAb）和TSH（pTSH）水平等各种因素，以预测完全缓解率。
结果
108例患者中，79.6%达到完全缓解，其余患者表现为不完全缓解（分别因生化不完全、结构不完全和不确定反应导致2.9%、5.5%和12%）。6例患者接受了新剂量的131-I。肿瘤大小和pAntiTgAb是与治疗反应相关的唯一因素（分别为P = 0.03和P < 0.01）。然而，pAntiTgAb是与完全缓解相关的唯一独立因素。完全缓解的患者pTg低于不完全缓解的患者（5.1±12.9 vs. 11.2±25 ng/mL），尽管无统计学意义（P = 0.14）。根据促甲状腺激素刺激方法，缓解率无显著差异。
结论
低剂量131-I足以使大多数LRDTC患者在随访6至12个月时达到完全缓解。肿瘤大小和pAntiTgAb变量与治疗反应相关。
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