分化型甲状腺癌¹³¹I后治疗反应动态变化及与复发危险分层和TNM分期的关系

Dynamic Changes in Treatment Response af-ter ¹³¹I in Differentiated Thyroid Cancer and Their Relationship with Recurrence Risk Stratification and TNM Staging

摘要: 目的：探讨分化型甲状腺癌(DTC) ¹³¹I后治疗反应的动态变化及与复发危险分层及TNM分期的关系。方法：选取行甲状腺全切术、术后病理证实为DTC且仅有淋巴结转移并行¹³¹I治疗患者，分析治疗反应变化及与随访时间、复发危险分层及TNM分期的关系。结果：(1) 423例DTC患者¹³¹I治疗后最佳治疗反应(ER)率、结构性改变(SIR)率与随访时间延长呈强正相关(r = 0.978、0.958，均P < 0.05)，而疗效不确定(IR)率、生化改变(BIR)率与时间呈强负相关(r = −0.971、−0.966，均P < 0.05)；与3个月比较，2年ER率、SIR率升高，IR率、BIR率降低，差异均有统计学意义(均P < 0.05)；进一步分析显示：ER中仅有4.4% (11/250)转变为非ER，而IR中63.41% (52/82)、BIR中25% (22/88)转变为ER；BIR中14.77% (13/88)转变为SIR；(2) 131I治疗后2年ER率与复发危险度高呈弱负相关(r = −0.210，P < 0.05)，BIR率、SIR率与之呈弱正相关(分别r = 0.160、0.191，均P < 0.05)，IR率与之无关(P > 0.05)；¹³¹I治疗后2年治疗反应与TNM分期呈无相关性(均P > 0.05)；(3) 不同复发危险分层及TNM分期中，ER率均随着时间延长而升高，与3个月比较，治疗后2年复发危险中、高危组及TNM-I期组ER率均明显升高(均P < 0.05)。结论：¹³¹I后治疗反应呈动态变化，大多数IR转变为ER；ER随时间延长而上升，随复发危险分层程度加重而下降，动态评估对治疗和管理有指导价值。

Abstract: Objective: To investigate the dynamics of treatment response after ¹³¹I in differentiated thyroid cancer (DTC) and its relationship with recurrence risk stratification and TNM staging. Methods: Pa-tients who underwent total thyroidectomy with postoperative pathologically confirmed DTC and only lymph node metastasis and were treated with ¹³¹I were selected to analyze the changes in re-sponse to treatment and the relationship with follow-up time, recurrence risk stratification, and TNM stage. Results: (1) The rates of best therapeutic response (ER) and structural alteration (SIR) after ¹³¹I treatment in 423 DTC patients showed strong positive correlation with the prolongation of follow-up time (r = 0.978, 0.958, both P < 0.05), whereas the rates of uncertainty of efficacy (IR) and biochemical alteration (BIR) showed strong negative correlation with time (r = −0.971, −0.966, both P < 0.05); compared with 3 months, the 2-year ER and SIR rates were increased, and the IR and BIR rates were decreased, all of which were statistically significant (all P < 0.05); further analysis showed that only 4.4% (11/250) of the ERs were converted to non-ERs, whereas 63.41% (52/82) of the IRs, and 25% (22/88) of the BIRs, were converted to ERs; BIRs 14.77% (13/88) converted to SIR; (2) ER rate at 2 years after 131I treatment was weakly negatively correlated with high risk of recurrence (r = −0.210, P < 0.05), BIR rate and SIR rate were weakly positively correlated ( r = 0.160, 0.191, respectively, both P < 0.05), and IR rate was not correlated (P > 0.05); there was no correlation between the response to treatment and TNM staging at 2 years after ¹³¹I treatment (both P > 0.05); (3) the ER rate increased with time in different recurrence risk stratification and TNM stage, and compared with 3 months, the ER rate was significantly higher in the intermediate- and high-risk groups of recurrence risk and the TNM-I stage group at 2 years after treatment (all P < 0.05). Conclusion: The response to treatment after ¹³¹I is dynamic, with most IR converted to ER; ER rises with prolonged time and decreases with the degree of recurrence risk stratification, and the dynamic assessment is valuable in guiding treatment and management.