~(131)I治疗分化型甲状腺癌伴肺转移的效果评价及其影响因素分析
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摘要
目的·评价碘-131(~(131)I)治疗分化型甲状腺癌(differentiated thyroid carcinoma,DTC)肺转移的效果,并分析影响其疗效的相关因素。方法·对2012年4月—2016年5月于上海交通大学医学院附属新华医院核医学科行~(131)I治疗的DTC肺转移患者(共95例,其中女性62例,男性33例),以血清甲状腺球蛋白水平结合18氟-氟代脱氧葡萄糖(~(18)F-fluorodeoxyglucose,~(18)F-FDG)正电子发射计算机断层扫描(positron-emission tomography/computed tomography,PET/CT)评价~(131)I的疗效。对性别、年龄、病理类型、~(131)I治疗前是否诊断肺转移、肺转移灶聚碘以及~(18)F-FDG摄取情况、肺部病灶数目及大小、肺外远处转移等可能影响疗效的因素使用秩和检验和χ~2检验行单因素分析,绘制受试者工作特征(receiver operating characteristic,ROC)曲线并进行多因素Logistic回归分析。结果·~(131)I治疗DTC肺转移的有效率为53.68%,无效率46.32%。单因素分析结果显示:患者年龄<45岁(P=0.004)、肺转移灶~(18)F-FDG最大标准摄取值(maximum standardized uptake value,SUV_(max))(P=0.004)、肺部病灶大小(P=0.000)、肺转移灶聚碘情况(P=0.022)、~(131)I治疗前是否诊断肺转移(P=0.000)及是否合并肺外远处转移(P=0.014)与疗效相关。用ROC曲线得出不同疗效的患者肺转移灶~(18)F-FDG SUV_(max)的临界值为1.45(敏感度56.8%,特异度76.5%),肺部病灶直径的临界值为9.63 mm(敏感度43.2%,特异度88.2%)。进一步的多因素分析结果显示:年龄、肺部病灶大小、肺转移灶~(18)F-FDG SUV_(max)、治疗前是否诊断肺转移是影响~(131)I治疗DTC肺转移的确定性因素。结论·~(131)I对DTC肺转移的疗效确切;DTC肺转移患者中,年龄<45岁,在~(131)I治疗前就已发现肺转移、肺转移灶~(18)F-FDG SUV_(max)低、肺部病灶直径<9.63 mm的患者~(131)I治疗效果好。
Objective · To investigate the curative efficacy and influential factors of ~(131)I treatment for pulmonary metastases from differentiated thyroid carcinoma(DTC). Methods · A total of 95 DTC patients(33 males and 62 females) with pulmonary metastasis who underwent ~(131)I treatment in Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, from April 2012 to May 2016 were retrospectively analyzed. The efficacy of ~(131)I treatment was assessed using determination of serum thyroglobulin level and ~(18)F-fluorodeoxyglucose positron-emission tomography/computed tomography(~(18)F-FDG PET/CT). The possible factors affecting efficacy included gender, age, pathological classification, wheteer pulmonary metastasis diagnosed before treatment, the iodine and ~(18)F-FDG uptake of pulmonary lesions, the size and number of lung lesions, extrapulmonary distant metastasis.Univariate analysis was performed using Rank test and χ~2 test, the critical value was obtained through receiver operating characteristic(ROC) curve and Logistic regression was also performed. Results · The rates of efficacy and inefficacy of ~(131)I treatment were 53.68% and 46.32%, respectively. Univariate analyses showed that maximum standardized uptake value(SUV_(max)) evaluated by ~(18)F-FDG PET/CT(P=0.004), the size of lung metastases(P=0.000),age<45 years(P=0.004), ~(131)I uptake(P=0.022), whether pulmonary metastasis diagnosed before treatment(P=0.000), extrapulmonary distant metastasis(P=0.014) were the factors influencing outcome of ~(131)I treatment. The critical value of ~(18)F-FDG uptake for patients obtained by ROC curve was 1.45(sensitivity of 56.8% and specificity of 76.5%) and the critical value of lung lesion diameter was 9.63 mm(sensitivity of 43.2% and specificity of 88.2%). Multivariate Logistic regression analysis showed that the influential factors included the age of patients, the size and ~(18)F-FDG SUV_(max) of lung metastases and whether pulmonary metastasis diagnosed before treatment. Conclusion · ~(131)I treatment is an effective method for pulmonary metastases from DTC. The patients aged less than 45 years, with the lung lesion size less than 9.63 cm, low ~(18)F-FDG SUV_(max) and diagnosed before treatment may have good response to ~(131)I treatment.
Objective · To investigate the curative efficacy and influential factors of ~(131)I treatment for pulmonary metastases from differentiated thyroid carcinoma(DTC). Methods · A total of 95 DTC patients(33 males and 62 females) with pulmonary metastasis who underwent ~(131)I treatment in Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, from April 2012 to May 2016 were retrospectively analyzed. The efficacy of ~(131)I treatment was assessed using determination of serum thyroglobulin level and ~(18)F-fluorodeoxyglucose positron-emission tomography/computed tomography(~(18)F-FDG PET/CT). The possible factors affecting efficacy included gender, age, pathological classification, wheteer pulmonary metastasis diagnosed before treatment, the iodine and ~(18)F-FDG uptake of pulmonary lesions, the size and number of lung lesions, extrapulmonary distant metastasis.Univariate analysis was performed using Rank test and χ~2 test, the critical value was obtained through receiver operating characteristic(ROC) curve and Logistic regression was also performed. Results · The rates of efficacy and inefficacy of ~(131)I treatment were 53.68% and 46.32%, respectively. Univariate analyses showed that maximum standardized uptake value(SUV_(max)) evaluated by ~(18)F-FDG PET/CT(P=0.004), the size of lung metastases(P=0.000),age<45 years(P=0.004), ~(131)I uptake(P=0.022), whether pulmonary metastasis diagnosed before treatment(P=0.000), extrapulmonary distant metastasis(P=0.014) were the factors influencing outcome of ~(131)I treatment. The critical value of ~(18)F-FDG uptake for patients obtained by ROC curve was 1.45(sensitivity of 56.8% and specificity of 76.5%) and the critical value of lung lesion diameter was 9.63 mm(sensitivity of 43.2% and specificity of 88.2%). Multivariate Logistic regression analysis showed that the influential factors included the age of patients, the size and ~(18)F-FDG SUV_(max) of lung metastases and whether pulmonary metastasis diagnosed before treatment. Conclusion · ~(131)I treatment is an effective method for pulmonary metastases from DTC. The patients aged less than 45 years, with the lung lesion size less than 9.63 cm, low ~(18)F-FDG SUV_(max) and diagnosed before treatment may have good response to ~(131)I treatment.
引文
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[8]崔静,高永举,武新宇.分化型甲状腺癌肺转移灶放射性碘治疗临床疗效评估[J].肿瘤影像学,2016,25(4):353-356.
[9]Sohn SY,Kim HI,Kim YN,et al.Prognostic indicators of outcomes in patients with lung metastases from differentiated thyroid carcinoma during long-term follow-up[J].Clin Endocrinol(Oxf),2017,88(2):318-326.
[10]Zhang X,Liu DS,Luan ZS,et al.Efficacy of radioiodine therapy for treating 20patients with pulmonary metastases from differentiated thyroid cancer and a metaanalysis of the current literature[J].Clin Transl Oncol,2018,20(7):928-935.
[11]王任飞,谭建,张桂芝,等.131I治疗分化型甲状腺癌肺转移的疗效评价及影响因素探讨[J].中华核医学与分子影像杂志,2015,35(4):258-261.
[12]Fatourechi V,Hay ID.Treating the patient with differentiated thyroid cancer with thyroglobulin-positive iodine-131 diagnostic scan-negative metastases:including comments on the role of serum thyroglobulin monitoring in tumor surveillance[J].Semin Nucl Med,2000,30(2):107-114.
[13]Castro MR,Bergert ER,Goellner JR,et al.Immunohistochemical analysis of sodium iodide symporter expression in metastatic differentiated thyroid cancer:correlation with radioiodine uptake[J].J Clin Endocrinol Metab,2001,86(11):5627-5632.
[14]Kim M,Kim WG,Park S,et al.Initial size of metastatic lesions is best prognostic factor in patients with metastatic differentiated thyroid carcinoma confined to the lung[J].Thyroid,2017,27(1):49-58.
[15]武凤玉,王振光.18F-FDG PET/CT显像在甲状腺肿瘤中的应用[J].中华核医学与分子影像杂志,2016,36(2):192-195.
[16]Qiu ZL,Wei WJ,Shen CT,et al.Diagnostic performance of 18F-FDG PET/CT in papillary thyroid carcinoma with negative 131I-WBS at first postablation,negative Tg and progressively increased Tg Ab level[J].Sci Rep,2017,7(1):2849.
[2]Mihailovic J,Stefanovic L,Malesevic M,et al.The importance of age over radioiodine avidity as a prognostic factor in differentiated thyroid carcinoma with distant metastases[J].Thyroid,2009,19(3):227-232.
[3]Cho SW,Choi HS,Yeom GJ,et al.Long-term prognosis of differentiated thyroid cancer with lung metastasis in Korea and its prognostic factors[J].Thyroid,2014,24(2):277-286.
[4]Chopra S,Garg A,Ballal S,et al.Lung metastases from differentiated thyroid carcinoma:prognostic factors related to remission and disease-free survival[J].Clin Endocrinol(Oxf),2015,82(3):445-452.
[5]Ito Y,Higashiyama T,Takamura Y,et al.Clinical outcomes of patients with papillary thyroid carcinoma after the detection of distant recurrence[J].World JSurg,2010,34(10):2333-2337.
[6]Eisenhauer EA,Therasse P,Bogaerts J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline(version 1.1)[J].Eur J Cancer,2009,45(2):228-247.
[7]Qiu ZL,Xue YL,Song HJ,et al.Comparison of the diagnostic and prognostic values of 99mTc-MDP-planar bone scintigraphy,131I-SPECT/CT and 18F-FDG-PET/CT for the detection of bone metastases from differentiated thyroid cancer[J].Nucl Med Commun,2012,33(12):1232-1242.
[8]崔静,高永举,武新宇.分化型甲状腺癌肺转移灶放射性碘治疗临床疗效评估[J].肿瘤影像学,2016,25(4):353-356.
[9]Sohn SY,Kim HI,Kim YN,et al.Prognostic indicators of outcomes in patients with lung metastases from differentiated thyroid carcinoma during long-term follow-up[J].Clin Endocrinol(Oxf),2017,88(2):318-326.
[10]Zhang X,Liu DS,Luan ZS,et al.Efficacy of radioiodine therapy for treating 20patients with pulmonary metastases from differentiated thyroid cancer and a metaanalysis of the current literature[J].Clin Transl Oncol,2018,20(7):928-935.
[11]王任飞,谭建,张桂芝,等.131I治疗分化型甲状腺癌肺转移的疗效评价及影响因素探讨[J].中华核医学与分子影像杂志,2015,35(4):258-261.
[12]Fatourechi V,Hay ID.Treating the patient with differentiated thyroid cancer with thyroglobulin-positive iodine-131 diagnostic scan-negative metastases:including comments on the role of serum thyroglobulin monitoring in tumor surveillance[J].Semin Nucl Med,2000,30(2):107-114.
[13]Castro MR,Bergert ER,Goellner JR,et al.Immunohistochemical analysis of sodium iodide symporter expression in metastatic differentiated thyroid cancer:correlation with radioiodine uptake[J].J Clin Endocrinol Metab,2001,86(11):5627-5632.
[14]Kim M,Kim WG,Park S,et al.Initial size of metastatic lesions is best prognostic factor in patients with metastatic differentiated thyroid carcinoma confined to the lung[J].Thyroid,2017,27(1):49-58.
[15]武凤玉,王振光.18F-FDG PET/CT显像在甲状腺肿瘤中的应用[J].中华核医学与分子影像杂志,2016,36(2):192-195.
[16]Qiu ZL,Wei WJ,Shen CT,et al.Diagnostic performance of 18F-FDG PET/CT in papillary thyroid carcinoma with negative 131I-WBS at first postablation,negative Tg and progressively increased Tg Ab level[J].Sci Rep,2017,7(1):2849.