摘要
目的探索分化型甲状腺癌(DTC)发生肺转移的危险因素及其对131I的疗效。方法纳入我院2013年1月至2019年6月收治入院的1854例确诊为DTC的患者其中肺转移45例,根据患者年龄、性别、病理类型、甲状腺炎、被膜侵犯、有无甲状腺外组织侵犯筛选出DTC肺转移的危险因素。并根据131I治疗效果,将45例肺转移分为有效和无效两组,比较两组年龄、性别、病理类型、手术方式、显影时机方面存在的差别,分析影响131I治疗DTC肺转移疗效的因素。结果131I治疗DTC伴肺转移有效率为55.56%(25/45)。单因素分析显示DTC病理类型滤泡癌、甲状腺外组织侵犯发生肺转移的风险显著增加(χ^2=41.388,11.9112,P均<0.05);年龄、性别、甲状腺炎对DTC发生肺转移无影响(χ^2=2.65,0.074,0.8290.118,P均>0.05);多因素logistic回归分析得病理类型、甲状腺外组织侵犯是DTC肺转移的独立影响因素(P=0.0000.001,OR=8.409,2.792);进一步对DTC肺转移的患者131I的疗效分析显示,年龄≥55岁患者,131I无效的比例显著高于年龄<55岁组(χ^2=6.252,P=0.012);而显影时机分析显示,首次治疗发现肺转移的患者有效比例为92%,显著高于随访发现肺转移患者比例8%,(χ^2=6.354,P=0.012)。多因素logistic回归分析得年龄、显影时机是131I疗效的独立影响因素。结论滤泡状癌、甲状腺外组织侵犯会增加DTC肺转移的风险且高龄、随访时发现肺转移的患者131I治疗疗效不佳。
Objective To explore risk factors for lung metastasis of differentiated thyroid carcinoma(DTC)and its effect on 131I.Methods From January 2013 to June 2019,1854 patients diagnosed with DTC admitted were enrolled.Among them,45 patients had lung metastasis.According to patients’age、gender、pathological type、thyroiditis、capsular invasion、whether there was invasion of extra-thyroid tissue,risk factors of DTC lung metastasis were screened out.And according to 131I treatment,45 cases of lung metastasis were divided into effective and ineffective groups.The differences in age、gender、pathological type、surgical method,and imaging time were compared,and factors affecting efficacy of 131I treatment of DTC lung metastases were analyzed.Results Effective rate of 131I to treat DTC with lung metastasis was 55.56%(25/45).Univariate analysis showed that lung metastasis risk of DTC pathological type follicular carcinoma and extra-thyroid tissue invasion was significantly increased(χ2=41.388,11.9112,P<0.05).Age,gender and thyroiditis had no effect on occurrence of lung metastasis of DTC(χ2=2.65,0.074,0.829,0.118,P>0.05).Multivariate logistic regression analysis showed that pathological types and invasion of thyroid tissue were independent influencing factors of DTC lung metastasis(P=0.000,0.001,OR=8.409,2.792).Further analysis of efficacy of 131I in patients with DTC lung metastasis showed that proportion of patients aged≥55 years old with 131I ineffective was significantly higher than that in group aged<55 years(χ2=6.252,P=0.012).The timing analysis showed that the effective proportion of patients with lung metastasis found in the first treatment was 92%,which was significantly higher than proportion of patients with lung metastasis found in follow-up 8%,(χ2=6.354,P=0.012).Multivariate logistic regression analysis showed that age and timing of imaging were independent factors influencing efficacy of 131I.Conclusion Follicular carcinoma and extra-thyroid tissue invasion could increase risk of DTC lung metastasis,and 131I therapy is not effective in elderly patients with lung metastases found during follow-up.
作者
郭明皓
马悦心
组木热提·吐尔洪
刘玉靖
董占飞
Guo Minghao;Ma Yuexin;Zumureti Tuerhong(Nuclear Medicine,the Third Clinical Medical College of Xinjiang Medical U-niversity,Urumqi,Xinjiang 830011,China)
出处
《四川医学》
CAS
2020年第12期1255-1259,共5页
Sichuan Medical Journal
基金
新疆医科大学大学生创新训练计划项目(编号:201910760013)。
关键词
分化型甲状腺癌
危险因素
肺转移
131I治疗
疗效
differentiated thyroid cancer
risk factors
lung metastasis
131I treatment
curative effect
