Health Insurance Review and Assessment Service, Seoul, Korea.
Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
J Clin Endocrinol Metab. 2021 Jun 16;106(7):e2580-e2588. doi: 10.1210/clinem/dgab192.
This study investigated radioactive iodine treatment (RAIT) patterns and the secondary cancer incidence among children and young adults receiving RAIT after thyroidectomy for thyroid cancer.
This population-based cohort study used the Health Insurance Review and Assessment database of South Korea to identify a total of 18 617 children and young adults (0-29 years) who underwent thyroidectomy for thyroid cancer between 2008 and 2018. We recorded age at surgery, sex, the interval from surgery to RAIT, the doses of RAI, the number of RAIT sessions, and secondary cancer incidence.
A total of 9548 (51.3%) children and young adults underwent 1 or more RAIT sessions. The initial dose of RAIT was 4.35 ± 2.19 GBq. The overall RAIT frequency fell from 60.9% to 38.5%, and the frequency of high-dose RAIT (>3.7 GBq) fell from 64.2% to 36.5% during the observational period. A total of 124 cases of secondary cancer developed during 120 474 person-years of follow-up; 43 (0.5%) in the surgery cohort and 81 (0.8%) in the RAIT cohort. Thus, the RAIT cohort was at an increased risk of secondary cancer (adjusted hazard ratio 1.52 [95% confidence interval 1.03-2.24], P = 0.035).
The proportion of children and young adults receiving RAIT, and the RAI dose, fell significantly over the observational period. RAIT was associated with secondary cancers. This is of major concern in the context of child and young adult thyroid cancer survivors.
本研究调查了甲状腺癌患者甲状腺切除术后接受放射性碘治疗（RAIT）的儿童和年轻成年人的 RAIT 模式和二次癌症发病情况。
本基于人群的队列研究使用了韩国健康保险审查和评估数据库，共确定了 18617 名（0-29 岁）在 2008 年至 2018 年间因甲状腺癌接受甲状腺切除术的儿童和年轻成年人。我们记录了手术时的年龄、性别、手术至 RAIT 的时间间隔、RAI 剂量、RAIT 次数以及二次癌症发病率。
共有 9548 名（51.3%）儿童和年轻成年人接受了 1 次或多次 RAIT 治疗。RAIT 的初始剂量为 4.35±2.19GBq。在观察期间，整体 RAIT 频率从 60.9%降至 38.5%，高剂量 RAIT（>3.7GBq）的频率从 64.2%降至 36.5%。在 120474 人年的随访中，共发生 124 例继发性癌症；手术组 43 例（0.5%），RAIT 组 81 例（0.8%）。因此，RAIT 组发生继发性癌症的风险增加（调整后的危险比 1.52[95%置信区间 1.03-2.24]，P=0.035）。
在观察期间，接受 RAIT 的儿童和年轻成年人比例以及 RAI 剂量均显著下降。RAIT 与继发性癌症有关。这在儿童和年轻成年人甲状腺癌幸存者的背景下引起了极大的关注。
