Altedlawi Albalawi Ibrahim A, Altidlawi Abdullah I, Mirghani Hyder
Surgical Oncology, University of Tabuk, Tabuk, SAU.
Surgery, University of Tabuk, Tabuk, SAU.
Cureus. 2020 Dec 28;12(12):e12332. doi: 10.7759/cureus.12332.
Radioactive iodine (RAI) is being increasingly used for remnants ablation of low/intermediate-risk differentiated thyroid carcinoma (DTC). Importantly, total thyroidectomy (TT) is in common use in the treatment of low-grade DTC to facilitate RAI despite the recommendations for lobectomy. Intermediate-risk DTC has been an arena of controversy (fueled by weighing the risks and benefits of RAI). This meta-analysis aimed to assess the role of RAI following TT in comparison to lobectomy in low/intermediate-risk patients with DTC. We identified 482 references through PubMed, Cochrane Library, EBSCO, and Google Scholar databases. The keywords used were "differentiated thyroid carcinoma", "low/intermediate risk", "radioactive iodine following total thyroidectomy", "total thyroidectomy versus lobectomy and RAI", "remnants ablation", "recurrence", "survival rate", "tumor-specific cancer death", "overall mortality", and "tumor-specific mortality". From the 67 full texts screened, only seven studies fulfilled the inclusion and exclusion criteria. The studies were from the USA, Australia, Asia, Mexico, and South America (63,268 patients included; five were retrospective and two prospective cohorts). No differences were found regarding recurrence and survival rate between TT followed by RAI and lobectomy alone. However, the current data were limited by the observational studies included, the pooling of both recurrence and survival rate, and the significant heterogeneity observed. The ongoing randomized controlled trials are awaited to resolve the issue.
放射性碘（RAI）越来越多地用于低/中危分化型甲状腺癌（DTC）的残留甲状腺组织消融。重要的是，尽管有推荐行甲状腺叶切除术，但全甲状腺切除术（TT）在低级别DTC治疗中仍普遍用于促进放射性碘治疗。中危DTC一直是一个有争议的领域（因权衡放射性碘治疗的风险和益处而引发）。这项荟萃分析旨在评估在低/中危DTC患者中，全甲状腺切除术后放射性碘治疗与甲状腺叶切除术相比的作用。我们通过PubMed、Cochrane图书馆、EBSCO和谷歌学术数据库检索到482篇参考文献。使用的关键词有“分化型甲状腺癌”、“低/中危”、“全甲状腺切除术后放射性碘治疗”、“全甲状腺切除术与甲状腺叶切除术及放射性碘治疗对比”、“残留甲状腺组织消融”、“复发”、“生存率”、“肿瘤特异性癌症死亡”、“总死亡率”和“肿瘤特异性死亡率”。在筛选的67篇全文中，只有7项研究符合纳入和排除标准。这些研究来自美国、澳大利亚、亚洲、墨西哥和南美洲（共纳入63268例患者；5项为回顾性研究，2项为前瞻性队列研究）。全甲状腺切除术后放射性碘治疗与单纯甲状腺叶切除术相比，在复发率和生存率方面未发现差异。然而，目前的数据受限于纳入的观察性研究、复发率和生存率的合并分析以及观察到的显著异质性。有待正在进行的随机对照试验来解决这一问题。
