N1期甲状腺微小乳头状癌和甲状腺非微小乳头状癌首次放射性碘消融治疗后的疗效及影响因素分析
Analysis of Curative Effect and Influencing Factors of N1 Stage Papillary Thyroid Micro-Carcinoma and Papillary Thyroid Non-Micro Carcinoma After Initial Radioactive Iodine Ablation Therapy.
作者信息
Yun Canhua, Wu Meiling, Xiao Juan, Liu Yong, Zhang Wei, Cao Jingjia
机构信息
Department of Nuclear Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People's Republic of China.
Center of Evidence-Based Medicine, Institute of Medical Sciences, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People's Republic of China.
出版信息
Cancer Manag Res. 2021 Feb 12;13:1427-1434. doi: 10.2147/CMAR.S292395. eCollection 2021.
OBJECTIVE
To compare the efficacy and influencing factors of initial radioactive iodine (RAI) ablation therapy for postoperative N1 stage papillary thyroid micro-carcinoma (PTMC) and papillary thyroid non-micro carcinoma (PTC), and to explore the necessity of RAI for N1 stage PTMC.
METHODS
A retrospective analysis of patients with N1 stage papillary thyroid cancer who underwent RAI in our department from January 2018 to June 2019. According to the tumor diameter, papillary thyroid carcinoma was divided into PTMC group (≤ 1.0cm) with 129 patients and PTC group (> 1.0 cm) with 214 patients. According to the 2015 ATA guidelines, the patient's treatment response was evaluated 6-8 months after discharge from the hospital: excellent response (ER), indeterminate response (IDR), biochemical incomplete response (BIR), and structural incomplete response (SIR). IDR, BIR, and SIR were classified into NER group. Chi-squared test, independent sample -test, Mann-Whitney test, and binary logistic regression analysis were used to compare the differences between PTMC and PTC patients.
RESULTS
The ps-Tg of the PTMC group was significantly lower than that of the PTC group ( = 0.001), and the ER ratio of the PTMC group was higher (χ = 5.445, < 0.05). The ER ratio of PTMC patients in the N1a group was significantly higher than that of PTC patients (80%, 66.7%, χ = 4.076, 0.05), while the ER ratio of PTMC in the N1b group was not significantly different from that of PTC. Gender, N stage, and ps-Tg were found to be independent factors of RAI treatment response.
CONCLUSION
The efficacy of the initial RAI of PTMC patients was significantly better than that of PTC patients. There was no significant difference in the efficacy of RAI between males with PTMC, N1b stage, ps-Tg ≥ 5.87ng/mL and PTC patients, which suggested that RAI is necessary for these patients.
目的
比较术后N1期甲状腺微小乳头状癌（PTMC）和甲状腺非微小乳头状癌（PTC）首次放射性碘（RAI）消融治疗的疗效及影响因素，探讨N1期PTMC行RAI治疗的必要性。
方法
回顾性分析2018年1月至2019年6月在我科接受RAI治疗的N1期甲状腺乳头状癌患者。根据肿瘤直径，将甲状腺乳头状癌分为PTMC组（≤1.0cm）129例和PTC组（>1.0cm）214例。根据2015年ATA指南，在患者出院6-8个月后评估治疗反应：良好反应（ER）、不确定反应（IDR）、生化不完全反应（BIR）和结构不完全反应（SIR）。IDR、BIR和SIR归为非ER组。采用卡方检验、独立样本t检验、Mann-Whitney检验和二元逻辑回归分析比较PTMC和PTC患者之间的差异。
结果
PTMC组的ps-Tg显著低于PTC组（P = 0.001），PTMC组的ER率更高（χ² = 5.445，P < 0.05）。N1a组PTMC患者的ER率显著高于PTC患者（80%，66.7%，χ² = 4.076，P < 0.05），而N1b组PTMC的ER率与PTC组无显著差异。发现性别、N分期和ps-Tg是RAI治疗反应的独立因素。
结论
PTMC患者首次RAI治疗的疗效显著优于PTC患者。PTMC男性、N1b期、ps-Tg≥5.87ng/mL患者与PTC患者的RAI疗效无显著差异，提示这些患者有必要行RAI治疗。
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