Treatment response of differentiated thyroid carcinoma with negative preablative stimulated thyroglobulin and iodine-positive lymph node after the first radioablation and influence factors analysis

中华核医学与分子影像杂志 Pub Date : 2020-01-25 DOI:10.3760/CMA.J.ISSN.2095-2848.2020.01.005

Chenghui Lu, Jiao Li, Xinfeng Liu, Guoqiang Wang, Zenghua Wang

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引用次数: 1

Abstract

Objective To investigate the response to 131I therapy and to explore the influence factors in postoperative differentiated thyroid carcinoma (DTC) patients with negative preablative stimulated thyroglobulin (psTg) and iodine-positive lymph node after the first radioablation. Methods From May 2016 to October 2018, 108 DTC patients (28 males, 80 females, age: (45.7±10.4) years) with negative psTg who underwent 131I treatment for the first time in the Affiliated Hospital of Qingdao University were retrospectively enrolled. All patients had iodine-positive lymph nodes, which were showed by SPECT/CT imaging 5-6 d after 131I treatment. The treatment response was evaluated at 6-24 month after 131I treatment. Patients were divided into excellent response (ER) group and non-excellent response (non-ER) group according to the response to the first 131I treatment. Independent-sample t test, χ2 test and Mann-Whitney U test were used to analyze differences of factors (e.g. age, gender, extraglandular infiltration) between the 2 groups, and then multivariate logistic regression was performed to find the influence factors for treatment response. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of the iodine-positive lymph node size in 131I treatment response. Results A total of 82 patients (75.93%, 82/108) achieved ER, and 26 (24.07%, 26/108) was non-ER patients. There were significant differences in age (t=-2.540, P=0.016), extraglandular infiltration (χ2=5.764, P=0.016), T stage (χ2=19.857, P<0.001), N stage (χ2=14.145, P=0.001), risk stratification of recurrence (χ2=11.487, P=0.003), ultrasound results before 131I treatment (χ2=44.819, P<0.001), dose of the first 131I treatment (U=780.0, P=0.018), size (long diameter) of iodine-positive lymph node (U=184.0, P<0.001), and psTg level (U=776.0, P=0.037) between ER and non-ER groups. Multivariate logistic regression showed that age, size of iodine-positive lymph node and ultrasound results before 131I treatment were closely related to 131I treatment response. The odds ratio (OR) values (95% CI) were 1.123 (1.025-1.231), 4.275 (1.893-9.653) and 260.86 (8.123-8 376.764), respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for non-ER were 100%(26/26), 70.73%(58/82), 77.78%(84/108), 52.00%(26/50) and 100%(58/58) respectively when the cut-off value of iodine-positive lymph node size was 5.5 mm. Conclusion The response of some DTC patients with negative psTg and iodine-positive lymph node after the first radioablation were non-ER. Age, ultrasound results before 131I treatment and size of iodine-positive lymph node are sensitive indicators for predicting clinical outcome in DTC patients with negative psTg and iodine-positive lymph node after the first radioablation. Key words: Thyroid neoplasms; Radiotherapy; Iodine radioisotopes; Thyroglobulin

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分化型甲状腺癌放疗后甲状腺球蛋白和碘阳性淋巴结清除前阴性的疗效及影响因素分析

目的探讨131I治疗分化型甲状腺癌（DTC）术后首次放疗后甲状腺球蛋白（psTg）阴性、淋巴结碘阳性患者的疗效及影响因素。方法回顾性分析2016年5月至2018年10月在青岛大学附属医院首次接受131I治疗的108例psTg阴性DTC患者（男28例，女80例，年龄（45.7±10.4）岁）。131I治疗后5～6d SPECT/CT显像显示所有患者均有碘阳性淋巴结。131I治疗后6-24个月评估治疗反应。根据对第一次131I治疗的反应，将患者分为优反应（ER）组和非优反应（非ER）组。采用独立样本t检验、χ2检验和Mann-Whitney U检验分析两组之间因素（如年龄、性别、腺外浸润）的差异，然后进行多元逻辑回归，找出影响治疗效果的因素。受试者操作特征（ROC）曲线用于评估碘阳性淋巴结大小在131I治疗反应中的预测价值。结果共有82例（75.93%，82/108）患者实现了ER，26例（24.07%，26/108）为非ER患者。年龄（t=-2.540，P=0.016）、腺外浸润（χ2=5.764，P=0.016，ER组和非ER组碘阳性淋巴结的大小（长径）（U=184.0，P<0.001）和psTg水平（U=776.0，P=0.037）。多因素logistic回归显示年龄、碘阳性淋巴结大小和131I治疗前超声检查结果与131I治疗反应密切相关。比值比（OR）值（95%CI）分别为1.123（1.025-1.231）、4.275（1.893-9.653）和260.86（8.123-8 376.764）。非ER的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为100%（26/26）、70.73%（58/82）、77.78%（84/108），碘阳性淋巴结大小的截断值为5.5mm时分别为52.00%（26/50）和100%（58/58）。年龄、131I治疗前的超声结果和碘阳性淋巴结的大小是预测首次放疗后psTg阴性和碘阳性的DTC患者临床结果的敏感指标。关键词：甲状腺肿瘤；放射治疗；碘放射性同位素；甲状腺球蛋白

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来源期刊

中华核医学与分子影像杂志核医学，分子影像

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期刊介绍： Chinese Journal of Nuclear Medicine and Molecular Imaging (CJNMMI) was established in 1981, with the name of Chinese Journal of Nuclear Medicine, and renamed in 2012. As the specialized periodical in the domain of nuclear medicine in China, the aim of Chinese Journal of Nuclear Medicine and Molecular Imaging is to develop nuclear medicine sciences, push forward nuclear medicine education and basic construction, foster qualified personnel training and academic exchanges, and popularize related knowledge and raising public awareness. Topics of interest for Chinese Journal of Nuclear Medicine and Molecular Imaging include: -Research and commentary on nuclear medicine and molecular imaging with significant implications for disease diagnosis and treatment -Investigative studies of heart, brain imaging and tumor positioning -Perspectives and reviews on research topics that discuss the implications of findings from the basic science and clinical practice of nuclear medicine and molecular imaging - Nuclear medicine education and personnel training - Topics of interest for nuclear medicine and molecular imaging include subject coverage diseases such as cardiovascular diseases, cancer, Alzheimer’s disease, and Parkinson’s disease, and also radionuclide therapy, radiomics, molecular probes and related translational research.