碘-131治疗可改善中危甲状腺癌患者的生存

近期，美国临床内分泌与代谢学杂志（JCEM）发表文章（Ruel E, Thomas S, Dinan M, Perkins JM, Roman SA, Sosa JA.Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer. J Clin Endocrinol Metab. 2015 Apr;100(4):1529-36.）证实了碘-131治疗可改善中危甲状腺乳头状癌患者的生存。为那些甲状腺癌术后患者是否应该接受碘-131治疗提供了重要参考依据。论著摘要翻如下：河南省肿瘤医院核医学科杨辉

摘要

背景：甲状腺乳头状癌是最常见的内分泌肿瘤，长期预后良好。但由于缺乏数据支持，碘-131辅助治疗对中危甲状腺乳头状癌患者的获益情况尚存争议。

目的：本研究目的在于验证碘-131辅助治疗对中危甲状腺乳头状癌患者的生存影响。

方法：研究共收纳了21 870例美国癌症数据库中在1998-2006年期间接受甲状腺全切术的中危甲状腺乳头状癌患者。根据ATA（美国甲状腺学会）和AJCC（美国癌症联合会）的相关定义，所谓中危包含以下两种类型： 1. T3（肿瘤局限于甲状腺内且最大径＞100px或伴有镜下甲状腺外侵犯，后者无论肿瘤大小）, N0（无淋巴结转移）, M0 or Mx（无远处转移或远处转移未评估）；2. T1-3（肿瘤局限于甲状腺内且最大径≤100px）, N1（有淋巴结转移）, M0, or Mx （无远处转移或远处转移未评估）。侵袭性亚型和多灶性甲状腺乳头状癌未列入本研究。

结果：研究发现，接受了碘-131辅助治疗的患者共15418例（70.5%），6452例（29.5%）患者未接受该治疗。平均随访时间为6年，最长达14年。总体而言，碘-131辅助治疗显著改善了患者的总生存(P < 0.001)。分组分析提示，无论在年轻患者亚组（年龄低于45岁，12612例, P = 0.002）还是在老年组 (年龄大于65岁, 2122例, P =0 .008)结果同样如此。根据人口统计和临床特征调整的多因素分析，碘-131辅助治疗将死亡风险降低了29%(P < 0.001)。对于年龄低于45岁的年轻患者，该治疗将死亡风险降低了36% (P =0.016).

结论：作为首个国家级研究，本研究证实了碘-131辅助治疗能够改善中危甲状腺乳头状癌患者的生存。我们建议中危甲状腺乳头状癌患者应该考虑接受碘-131辅助治疗。

原文如下：

Ruel E, Thomas S, Dinan M, Perkins JM, Roman SA, Sosa JA. Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer. J Clin Endocrinol Metab. 2015 Apr;100(4):1529-36.

Abstract

CONTEXT:

Papillary thyroid cancer (PTC) is the most common endocrine malignancy. The long-term prognosis is generally excellent. Due to a paucity of data, debate exists regarding the benefit of adjuvant radioactive iodine therapy (RAI) for intermediate-risk patients.

OBJECTIVE:

The objective of the study was to examine the impact of RAI on overall survival in intermediate-risk PTC patients.

DESIGN/SETTING:

Adult patients with intermediate-risk PTC who underwent total thyroidectomy with/without RAI in the National Cancer Database, 1998-2006, participated in the study.

PATIENTS:

Intermediate-risk patients, as defined by American Thyroid Association risk and American Joint Commission on Cancer disease stage T3, N0, M0 or Mx, and T1-3, N1, M0, or Mx were included in the study. Patients with aggressive variants and multiple primaries were excluded.

MAIN OUTCOME MEASURES:

Overall survival (OS) for patients treated with and without RAI using univariate and multivariate regression analyses was measured.

RESULTS:

A total of 21 870 patients were included; 15 418 (70.5%) received RAI and 6452 (29.5%) did not. Mean follow-up was 6 years, with the longest follow-up of 14 years. In an unadjusted analysis, RAI was associated with improved OS in all patients (P < .001) as well as in a subgroup analysis among patients younger than 45 years (n = 12 612, P = .002) and 65 years old and older (median OS 140 vs128 mo, n = 2122, P = .008). After a multivariate adjustment for demographic and clinical factors, RAI was associated with a 29% reduction in the risk of death, with a hazard risk 0.71 (95% confidence interval 0.62-0.82, P < .001). For age younger than 45 years, RAI was associated with a 36% reduction in risk of death, with a hazard risk 0.64 (95% confidence interval 0.45- 0.92, P = .016).

CONCLUSION:

This is the first nationally representative study of intermediate-risk PTC patients and RAI therapy demonstrating an association of RAI with improved overall survival. We recommend that this patient group should be considered for RAI therapy.

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