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手术后行131Ι治疗的中高危甲状腺乳头状癌患者复发的危险因素分析

Factors associated with recurrence of thyroid papillary carcinoma after radiation iodine therapy

    摘要
  • 摘要:
      背景  甲状腺乳头状癌(papillary thyroid carcinoma，PTC)术后复发率高达30%，而目前中高危PTC患者131I治疗后相关预后研究较少。
      目的  探讨手术后行131Ι治疗的中高危PTC患者复发危险因素。
      方法  收集2015年1月- 2016年12月在解放军总医院第一医学中心初次行甲状腺手术并于术后行131I治疗的中高危PTC患者临床资料进行回顾性分析，探讨复发的相关危险因素并行生存分析。
      结果  共纳入305例患者，男性96例，女性209例，年龄15 ~ 81(41.7±11.9)岁，中危223例(73.1%)，高危82例(26.9%)，I ~ Ⅱ期292例(95.7%)，Ⅲ ~ Ⅳ期13例(4.3%)。随访时间3 ~ 85个月，中位随访时间70个月，44例(14.4%)复发。单因素和多因素Cox回归分析显示年龄≥55岁(HR=2.774；95%CI：1.420-5.418；P=0.003)、多灶癌(HR=2.464；95% CI：1.302-4.663；P=0.006)、腺外侵犯(HR=3.455；95% CI ：1.589-7.510；P=0.002)、颈侧区淋巴结转移(lateral lymph node metastasis，LLNM)(HR=13.446；95% CI ：5.524-32.733；P<0.001)是术后复发的独立危险因素。
      结论  重视PTC的早期规范化治疗，年龄≥55岁、多灶癌、腺外侵犯、LLNM等因素与PTC复发密切相关，伴以上特征者行131I治疗后应重点关注。

     

    Abstract:
      Background  Since the recurrence rate of papillary thyroid carcinoma is as high as 30% after surgery, and there are few studies on the prognosis of moderate and high-risk PTC patients after 131I treatment.
      Objective  To investigate the factors associated with recurrence of papillary thyroid carcinoma (PTC) after radioiodine therapy.
      Methods  Clinical data about middle-high-risk PTC patients who underwent thyroid surgery for the first time and postoperative radioiodine therapy in the First Medical Center of Chinese PLA General Hospital from January 2015 to December 2016 were retrospectively analyzed to explore the risk factors related to recurrence.
      Results  A total of 305 patients were included, including 96 males and 209 females, aged from 15 to 81 (41.7±11.9) years, 223 cases (73.1%) at intermediate risk, 82 cases (26.9%) at high risk, 292 cases (95.7%) at stage I-Ⅱ, 13 cases (4.3%) at stage Ⅲ-Ⅳ. The follow-up time span was 3-85 months, with median follow-up time of 70 months, and 44 (14.4%) cases had recurrence. Univariate and multivariate Cox regression analysis showed that age ≥ 55 years (HR=2.774, 95% CI: 1.420-5.418, P=0.003), multifocal carcinoma (HR=2.464, 95% CI: 1.302-4.663, P=0.006), extra-gland invasion (HR=3.455, 95% CI: 1.589-7.510, P=0.002) and lateral lymph node metastasis (LLNM)(HR=13.446, 95% CI: 5.524-32.733, P<0.001) were independent risk factors for postoperative recurrence.
      Conclusion  Attention should be paid to early standardized treatment of PTC. Age ≥55 years, multifocal carcinoma, extra-glandular invasion and LLNM are closely related to recurrence. Postoperative attention should be paid to patients with these features.

     

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