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低剂量放射性碘消融在低危和中危分化型甲状腺癌中的疗效:一项回顾性比较分析

Efficacy of Low-Dose Radioiodine Ablation in Low- and Intermediate-Risk Differentiated Thyroid Cancer: A Retrospective Comparative Analysis.

作者信息

Gómez-Pérez Ana María, García-Alemán Jorge, Molina-Vega María, Sebastián Ochoa Arantzazu, Pérez García Pilar, Mancha Doblas Isabel, Tinahones Francisco J

机构信息

Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain.

Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain.

出版信息

J Clin Med. 2020 Feb 21;9(2):581. doi: 10.3390/jcm9020581.

Abstract

(1) Background-low-dose radioiodine ablation is an accepted strategy for the treatment of low- and intermediate-risk thyroid carcinomas, although there is no international consensus. The aim of this study is to describe the clinical experience with low-dose radioiodine ablation in patients with low- and intermediate-risk thyroid cancer compared to high-dose ablation. (2) Methods-174 patients with low- and intermediate-risk thyroid cancer, 90 treated with low-dose ablation and 84 treated with high-dose ablation, were included. The primary endpoint was response to treatment one year after ablation, defined by stimulated thyroglobulin, whole body scan and ultrasound imaging. (3) Results-an excellent response rate of 79.8% in the low-dose group and 85.7% in the high-dose group was observed ( = 0.049). Stimulated thyroglobulin at the moment of ablation ( = 0.032) and positive antithyroglobulin antibodies ( < 0.001) were independent predictive factors for nonexcellent response. Young age ( = 0.023), intermediate initial recurrence risk ( < 0.001) and low-dose ablation ( = 0.004) were independent predictive factors for recurrence. (4) Conclusion-low-dose ablation seemed to be less effective than high-dose ablation, especially in those patients with positive antithyroglobulin antibodies or higher stimulated thyroglobulin levels at the moment of ablation. Low dose was associated with higher recurrence rates, and lower age and intermediate initial recurrence risk were independent risk factors for recurrence in our sample.

摘要

(1) 背景——低剂量放射性碘消融是治疗低危和中危甲状腺癌的一种公认策略,尽管尚无国际共识。本研究的目的是描述低危和中危甲状腺癌患者低剂量放射性碘消融与高剂量消融相比的临床经验。(2) 方法——纳入174例低危和中危甲状腺癌患者,其中90例接受低剂量消融治疗,84例接受高剂量消融治疗。主要终点是消融后一年的治疗反应,通过刺激甲状腺球蛋白、全身扫描和超声成像来定义。(3) 结果——低剂量组的良好反应率为79.8%,高剂量组为85.7%(P = 0.049)。消融时的刺激甲状腺球蛋白(P = 0.032)和抗甲状腺球蛋白抗体阳性(P < 0.001)是反应不佳的独立预测因素。年轻(P = 0.023)、初始复发风险为中危(P < 0.001)和低剂量消融(P = 0.004)是复发的独立预测因素。(4) 结论——低剂量消融似乎比高剂量消融效果差,尤其是在消融时抗甲状腺球蛋白抗体阳性或刺激甲状腺球蛋白水平较高的患者中。低剂量与较高的复发率相关,在我们的样本中,年龄较小和初始复发风险为中危是复发的独立危险因素。

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