放射性碘消融治疗可降低儿童分化型甲状腺癌复发的风险。

Radioactive iodine ablation therapy reduces the risk of recurrent disease in pediatric differentiated thyroid carcinoma.

机构信息

Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, 70112, USA; Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt.

School of Medicine, Tulane University, New Orleans, LA, 70112, USA.

出版信息

Surg Oncol. 2024 Oct;56:102120. doi: 10.1016/j.suronc.2024.102120. Epub 2024 Aug 8.

DOI:10.1016/j.suronc.2024.102120

PMID:39154543

Abstract

BACKGROUND

While radioactive iodine (RAI) therapy in older adults with differentiated thyroid carcinoma (DTC) reduces recurrence, data in pediatrics remain limited. We conducted a meta-analysis to quantify outcomes and recurrence risk with RAI versus thyroidectomy alone in the pediatric population.

METHODS

Systematic literature review identified 34 retrospective studies including 2913 DTC patients under age 22 years (published 2005-2023). Meta-analysis calculated pooled rates of disease persistence and recurrence. Relative risk ratios compared odds of recurrence with RAI versus no RAI.

RESULTS

Patients had mean age 14.7 years (95 % CI, 14.2-15.2) and were 75.9 % female (95 % CI, 73.8-78.1 %). Majority (90.2 %) received RAI. Pooled persistence rate was 30.3 % (95 % CI, 21.7-39.5 %); higher with RAI (31.5 %; 95 % CI, 22.4-41.3 %) than no RAI (4.5 %; 95 % CI, 0.0-18.7 %) (OR 3.28; 95 % CI,1.82-5.91; p < 0.001). Recurrence rate was 8.97 % (95 % CI, 4.78-14.3 %). Those with RAI had 53.1 % lower recurrence risk versus no RAI (RR 0.47; 95 % CI, 0.27-0.82; p = 0.007). Median follow-up was 7.2 years (95 % CI, 5.8-8.5 years), with no association between follow-up duration and recurrence (r = -0.053; p = 0.80).

CONCLUSIONS

RAI therapy as an adjunct to thyroidectomy is associated with a significantly lower risk of long-term recurrence in pediatric DTC. These findings advocate for the use of RAI in preventing recurrence among high-risk pediatric patients with DTC.

摘要

背景

放射性碘（RAI）治疗老年分化型甲状腺癌（DTC）可降低复发率，但儿科数据仍有限。我们进行了一项荟萃分析，以量化 RAI 与单独甲状腺切除术在儿科人群中的结局和复发风险。

方法

系统文献回顾确定了 34 项回顾性研究，包括 2913 名年龄在 22 岁以下的 DTC 患者（发表于 2005-2023 年）。荟萃分析计算了疾病持续存在和复发的汇总率。相对风险比比较了 RAI 与无 RAI 的复发几率。

结果

患者的平均年龄为 14.7 岁（95%置信区间，14.2-15.2），女性占 75.9%（95%置信区间，73.8-78.1%）。大多数（90.2%）接受了 RAI。汇总的持续率为 30.3%（95%置信区间，21.7-39.5%）；RAI 组（31.5%；95%置信区间，22.4-41.3%）高于无 RAI 组（4.5%；95%置信区间，0.0-18.7%）（OR 3.28；95%置信区间，1.82-5.91；p<0.001）。复发率为 8.97%（95%置信区间，4.78-14.3%）。与无 RAI 相比，RAI 组的复发风险降低了 53.1%（RR 0.47；95%置信区间，0.27-0.82；p=0.007）。中位随访时间为 7.2 年（95%置信区间，5.8-8.5 年），复发与随访时间之间无关联（r=-0.053；p=0.80）。