J Clin Endocrinol Metab 2011 Oct;96 (10): 3078-86. [IF:6.495]
Efficacy and survival analysis of 131I therapy for bone metastases from differentiated thyroid cancer.
Qiu ZL , Song HJ , Xu YH , Luo QY .
Department of Nuclear Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, People's Republic of China. lqyn@sh163.net.
上海交通大学核医学科，上海市第六人民医院
Abstract
Our objective was to investigate the clinical efficacy of (131)I therapy for bone metastases from differentiated thyroid cancer (DTC) and prognostic factors as well as to assess patient survival and variables influencing survival. One hundred six DTC patients with bone metastases treated with (131)I were retrospectively analyzed. The therapeutic efficacy was evaluated based on the change in serum thyroglobulin (Tg), the palliation of bone pain, and the anatomical imaging changes in bone lesions. The overall survival rates were estimated using the life-table method. After (131)I therapy, a significant decrease in serum Tg was seen in 37 cases (34.9%), and serum Tg remained stable in 56 patients (52.8%). Among the 61 patients with painful bone metastases, 39 patients obtained a significant relief of bone pain, and the effective rate was 63.9%. The majority of DTC patients (76.4%) exhibited no obvious anatomical imaging changes in metastatic bone lesions after (131)I therapy. Only histopathological type and whether combined with nonosseous distant metastases had statistically significant impacts on changes in serum Tg (P = 0.009 and 0.023), and age over 45 yr and papillary thyroid carcinoma had favorable response on changes in anatomical imaging (P = 0.027 and 0.014). The 5- and 10-yr survival rates were 86.5 and 57.9%, respectively. Multivariate analyses showed that the presence of solitary bone metastases, only bone metastases, and (131)I therapy with previous bone surgery were independent factors associated with a better prognosis (P = 0.024, 0.009, and 0.031). (131)I therapy is a feasible and effective treatment for DTC bone metastases. A better prognosis can be accomplished in patients who had a single metastatic lesion, only bone metastasis, or underwent bone surgery before (131)I therapy.
摘要
我们的目的是调查I131对于不同甲状腺肿瘤骨转移治疗的临床有效性和预后因素，以及评价患者生存率和影响生存率的因素。对106名有骨转移并且使用I131治疗的甲状腺肿瘤患者进行回顾性分析。疗效的评价是基于血清中甲状腺球蛋白的改变、骨痛的缓解和骨中解剖影像学改变。通过使用生存曲线法来评价总体生存率。使用I131治疗后，有37名患者（34.9%）出现了显著血清甲状腺球蛋白的降低，56名患者（52.8%）血清甲状腺球蛋白量保持不变。在61名出现疼痛性骨转移的患者中，39名获得了骨痛的显著缓解，有效率达63.9%。绝大多数的甲状腺肿瘤患者（76.4%）在进行I131治疗后骨转移的区域没有出现明显的解剖影像学变化。只有组织病理学类型和是否同时伴有远处转移的类型对血清甲状腺球蛋白改变有显著的影响(P = 0.009 and 0.023),年龄大于45岁的患者及乳头状甲状腺癌的患者在解剖影像学变化上有良好的反应。5年和10年的生存率分别是86.5%和57.9%。多元分析显示存在单个转移灶，只存在骨转移，和既往骨手术和I131治疗是良好预后的独立影响因子(P = 0.024, 0.009, 和0.031)。对于甲状腺肿瘤骨转移的患者而言，I131治疗是易得到和有效的治疗。只有单个转移灶的患者、仅有骨转移的患者或在I131治疗前经过骨手术治疗的患者有较好的预后。
