摘要/Abstract

摘要： 目的 ·评价碘 -131（131I）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 131I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（ 18F-fluorodeoxyglucose， 18F-FDG）正电子发射计算机断层扫描（ positron-emission tomography/computed tomography，PET/CT）评价 131I的疗效。对性别、年龄、病理类型、 131I治疗前是否诊断肺转移、肺转移灶聚碘以及 18F-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 χ2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 · 131I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（P0.004）、肺转移灶 18F-FDG最大标准摄取值（ maximum standardized uptake value，SUVmax）(P0.004)、肺部病灶大小（ P0.000）、肺转移灶聚碘情况（ P0.022）、131I治疗前是否诊断肺转移（ P0.000）及是否合并肺外远处转移 (P0.014）与疗效相关。用 ROC曲线得出不同疗效的患者肺转移灶 18F-FDG SUVmax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 18F-FDG SUVmax、治疗前是否诊断肺转移是影响 131I治疗 DTC肺转移的确定性因素。结论 · 131I对 DTC肺转移的疗效确切； DTC肺转移患者中，年龄 < 45岁，在 131I治疗前就已发现肺转移、肺转移灶 18F-FDG SUVmax低、肺部病灶直径 < 9.63 mm的患者 131I治疗效果好。
关键词: 甲状腺肿瘤, 肿瘤转移, 肺, 放射疗法, 碘放射性同位素
Abstract:
Objective · To investigate the curative efficacy and influential factors of 131I treatment for pulmonary metastases differentiated thyroid carcinoma (DTC). Methods · A total of 95 DTC patients (33 males and 62 females) with pulmonary metastasis who underwent 131I treatment in Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, April 2012 to May 2016 were retrospectively analyzed. The efficacy of 131I treatment was assessed using determination of serum thyroglobulin level and 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT). The possible factors affecting efficacy included gender, age, pathological classification, wheteer pulmonary metastasis diagnosed before treatment, the iodine and 18F-FDG uptake of pulmonary lesions, the size and number of lung lesions, extrapulmonary distant metastasis. Univariate analysis was performed using Rank test and χ2 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 131I treatment were 53.68% and 46.32%, respectively. Univariate analyses showed that maximum standardized uptake value (SUVmax) evaluated18F-FDG PET/CT (P0.004), the size of lung metastases (P0.000), age<45 years (P0.004), 131I uptake (P0.022), whether pulmonary metastasis diagnosed before treatment (P0.000), extrapulmonary distant metastasis (P0.014) were the factors influencing outcome of 131I treatment. The critical value of 18F-FDG uptake for patients obtainedROC 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 18F-FDG SUVmax of lung metastases and whether pulmonary metastasis diagnosed before treatment. Conclusion · 131I treatment is an effective method for pulmonary metastases DTC. The patients aged less than 45 years, with the lung lesion size less than 9.63 cm, low 18F-FDG SUVmax and diagnosed before treatment may have good response to 131I treatment. [Key words]thyroid neoplasm; neoplasm metastasis; lung; radiotherapy; iodine radioisotope
Key words: thyroid neoplasm, neoplasm metastasis, lung, radiotherapy, iodine radioisotope


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