131I治疗分化型甲状腺癌肺转移疗效及影响因素的研究

摘要

Objective To evaluate the efficacy and influencing factors of 131Ⅰ therapy for lung metastases of differentiated thyroid carcinoma ( DTC). Methods Forty eight patients with lung metastases of DTC who received 131Ⅰ treatment in Department of Nuclear Medicine of West China Hospital from September 2004 to March 2007 were retrospectively reviewed. The efficacy and influencing factors of 131Ⅰ therapy was evaluated with univariate and multivariate analysis. Results In 48 cases with lung metastases of DTC, the complete remission rate of 131Ⅰ therapy was 10.4% , the response rate was 62. 5% and no response rate was 37. 5%. Univariate logistic regression analysis showed that the age, chest X-Ray or CT findings, distant metastases other than lung, serum thyroglobulin levels at diagnosis and lung 131Ⅰ uptake rate were factors influencing outcome of 131Ⅰ therapy; sex, histology, cervical lymph node metastases and thyroid remnants had no influence on efficacy. Multivariate logistic regression analysis showed that distant metastases other than lung, serum thyroglobulin levels at diagnosis and lung 131Ⅰ uptake rate were the influencing factors. Conclusion 131Ⅰ therapy is an effective and safe method for lung metastases of DTC and some factors would influence the efficacy of the therapy.%目的 通过对131I治疗DTC肺转移的回顾性研究,评价131I治疗DTC肺转移的疗效;结合疗效,对可能影响131I治疗DTC肺转移疗效的多种因素进行分析.方法 回顾性研究2004年9月至2007年3月期间在华西医院核医学科进行131I治疗的48例DTC肺转移患者,评价131I治疗DTC肺转移的疗效,对可能影响131I治疗DTC肺转移疗效的多种因素进行单因素和多因素分析.结果 按照131I治疗DTC肺转移的疗效评价标准,48例DTC肺转移患者治愈率10.5％、有效率62.5％、无效率37.5％.(1)单因素Logistic回归分析显示:年龄、胸部X线或CT、除肺之外的远处转移、确诊肺转移时的血Tg水平和肺摄取131I率等是影响131I治疗DTC肺转移疗效的因素;性别、肿瘤病理学类型、颈部淋巴结转移、残留甲状腺组织等时131I治疗DTC肺转移疗效无明显影响.(2)多因素逐步Logistic回归分析显示:远处转移、确诊肺转移时的血Tg水平和肺摄取131I率等是影响131I治疗DTC肺转移疗效的主要因素.结论 131I治疗DTC肺转移有较好的疗效.DTC肺转移患者中,无肺之外的远处转移、确诊时的血Tg水平低和肺摄取131I率高的患者1231I治疗效果好.总之,131I治疗DTC肺转移是一种安全有效的治疗方法,通过对131I治疗DTC肺转移疗效和影响因素的研究总结,对今后提高131I治疗效果有较好的指导意义.