Medical School, University of Toronto, Toronto, Canada.
Endocrinology Fellowship, University of Toronto, Toronto, Canada.
Thyroid. 2018 Dec;28(12):1662-1673. doi: 10.1089/thy.2018.0244. Epub 2018 Nov 27.
The potential risk of subsequent malignant neoplasms (SMNs) after radioactive iodine (RAI) treatment of thyroid cancer (TC) is an important concern. A systematic review was updated comparing the risk of SMNs in TC patients treated with RAI to TC patients without RAI. Six electronic databases were searched (up to March, 2018), supplemented with a hand search. Two reviewers independently screened citations, reviewed full-text papers, and critically appraised/abstracted data. Random-effects meta-analyses were conducted using crude data and data statistically adjusted for confounders. The outcomes were any SMN and specific SMNs for which sufficient data were available. In total, 3506 unique electronic search citations and 93 full-text papers were examined, including 17 studies (3 systematic reviews and 14 original studies). Published knowledge syntheses were limited by inclusion of small numbers of studies, with two systematic reviews suggesting an increased risk of any SMN and one meta-analysis suggesting a reduced risk of breast SMN after RAI treatment. In a meta-analysis of crude data, the risk ratio of any SMN in RAI-treated TC patients was 0.98 ([confidence interval (CI) 0.76-1.27]; = 10 studies of 65,539 individuals, heterogeneity Q = 64.26, degrees of freedom [df] = 9, < 0.001, = 85.99). The pooled risk ratio for any SMN, adjusted for confounders, was 1.16 ([CI 0.97-1.39]; = 6 studies, data from at least 11,241 TC patients, = 10.86, df = 5, = 0.054, = 53.96). In secondary analyses examining specific SMNs, although relatively rare, the risk of subsequent leukemia was increased, but the risk of multiple myeloma was reduced in RAI-treated TC patients. There was no significant increased relative risk of breast cancer, salivary cancer, or combined hematologic malignancies according to RAI treatment status. The body of evidence on whether I treatment of thyroid cancer is associated with the primary outcome of any SMN is highly heterogeneous and complex. More research examining the long-term risk of specific SMNs after I treatment is needed.
放射性碘（RAI）治疗甲状腺癌（TC）后发生继发恶性肿瘤（SMNs）的潜在风险是一个重要关注点。我们更新了一项系统评价，比较了接受 RAI 治疗和未接受 RAI 治疗的 TC 患者发生 SMNs 的风险。我们检索了 6 个电子数据库（截至 2018 年 3 月），并辅以手工检索。两位评审员独立筛选引文，审查全文论文，并批判性地评估/提取数据。使用原始数据和针对混杂因素进行统计学调整的数据进行随机效应荟萃分析。结局是任何 SMN 和有足够数据的特定 SMN。总共检查了 3506 个独特的电子搜索引文和 93 篇全文论文，包括 17 项研究（3 项系统评价和 14 项原始研究）。已发表的知识综合受纳入研究数量较少的限制，两项系统评价表明 RAI 治疗后任何 SMN 的风险增加，一项荟萃分析表明 RAI 治疗后乳腺癌 SMN 的风险降低。在一项原始数据荟萃分析中，RAI 治疗的 TC 患者发生任何 SMN 的风险比为 0.98（[置信区间（CI）0.76-1.27]； = 10 项研究，65539 人，异质性 Q=64.26，自由度[df] = 9， < 0.001， = 85.99）。调整混杂因素后任何 SMN 的汇总风险比为 1.16（[CI 0.97-1.39]； = 6 项研究，至少 11241 例 TC 患者的数据， = 10.86，df = 5， = 0.054， = 53.96）。在检查特定 SMN 的次要分析中，尽管相对罕见，但 RAI 治疗的 TC 患者发生继发白血病的风险增加，而多发性骨髓瘤的风险降低。根据 RAI 治疗情况，乳腺癌、唾液腺癌或血液系统恶性肿瘤的相对风险无显著增加。关于放射性碘治疗甲状腺癌是否与任何 SMN 的主要结局相关的证据体高度异质且复杂。需要更多研究来检查 I 治疗后特定 SMN 的长期风险。
