131I 治疗在生化持续分化型甲状腺癌患者中的作用。
Usefulness of second 131I treatment in biochemical persistent differentiated thyroid cancer patients.
机构信息
Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy.
Department of Surgical, Medical, Molecular Pathology and Critical Area, Anatomic Pathology Section, University Hospital of Pisa, Pisa, Italy.
出版信息
Eur Thyroid J. 2023 Oct 18;12(6). doi: 10.1530/ETJ-23-0052. Print 2023 Dec 1.
BACKGROUND
Second 131I treatment is commonly performed in clinical practice in patients with differentiated thyroid cancer and biochemical incomplete or indeterminate response (BiR/InR) after initial treatment.
OBJECTIVE
The objective of the is study is to evaluate the clinical impact of the second 131I treatment in BiR/InR patients and analyze the predictive factors for structural incomplete response (SiR).
PATIENTS AND METHODS
One hundred fifty-three BiR/InR patients after initial treatment who received a second 131I treatment were included in the study. The clinical response in a short- and medium- long-term follow-up was evaluated.
RESULTS
After the second 131I treatment (median 8 months), 11.8% patients showed excellent response (ER), 17% SiR, while BiR/InR persisted in 71.2%. Less than half (38.5%) of SiR patients had radioiodine-avid metastases. Patients who, following the second 131I treatment, experienced SiR had larger tumor size and more frequently aggressive histology and vascular invasion than those experienced BiR/InR and ER. Also, the median values of thyroglobulin on levothyroxine therapy (LT4-Tg), Tg peak after recombinant human TSH stimulation (rhTSH-Tg) and thyroglobulin antibodies (TgAb) were significantly higher in patients who developed SiR. At last evaluation (median: 9.9 years), BiR/InR persisted in 57.5%, while 26.2% and 16.3% of the patients showed ER and SiR, respectively. About half of BiR/InR patients (71/153 (46.4%)) received further treatments after the second 131I treatment.
CONCLUSIONS
Radioiodine-avid metastatic disease detected by the second 131I is an infrequent finding in patients with BiR/InR after initial treatment. However, specific pathologic and biochemical features allow to better identify those cases with higher probability of developing SiR, thus improving the clinical effectiveness of performing a second 131I treatment.
背景
在初始治疗后出现生化不完全缓解（BiR/InR）的分化型甲状腺癌患者中，临床实践中通常会进行第二次碘-131 治疗。
目的
本研究旨在评估第二次碘-131 治疗在 BiR/InR 患者中的临床影响，并分析结构不完全缓解（SiR）的预测因素。
患者和方法
本研究纳入了 153 例初始治疗后出现 BiR/InR 的患者，他们接受了第二次碘-131 治疗。在短期和中长期随访中评估了临床反应。
结果
第二次碘-131 治疗后（中位时间 8 个月），11.8%的患者表现为极好缓解（ER），17%的患者出现 SiR，而 BiR/InR 持续存在于 71.2%的患者中。不到一半（38.5%）的 SiR 患者存在放射性碘摄取转移灶。与 BiR/InR 和 ER 患者相比，接受第二次碘-131 治疗后出现 SiR 的患者肿瘤较大，侵袭性组织学和血管侵犯更常见。此外，在接受第二次碘-131 治疗后出现 SiR 的患者中，甲状腺球蛋白在左甲状腺素治疗下（LT4-Tg）、重组人促甲状腺激素刺激后甲状腺球蛋白（rhTSH-Tg）和甲状腺球蛋白抗体（TgAb）的中位数明显更高。最后一次评估（中位时间：9.9 年）时，BiR/InR 持续存在于 57.5%的患者中，而 26.2%和 16.3%的患者分别表现为 ER 和 SiR。大约一半的 BiR/InR 患者（71/153（46.4%））在第二次碘-131 治疗后接受了进一步治疗。
结论
在初始治疗后出现 BiR/InR 的患者中，通过第二次碘-131 检测到放射性碘摄取转移灶是一种不常见的发现。然而，特定的病理和生化特征可以更好地识别那些更有可能出现 SiR 的病例，从而提高进行第二次碘-131 治疗的临床效果。
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