Adjuvant Radioactive Iodine Therapy Is Associated With Improved Survival for Patients With Intermediate-Risk Papillary Thyroid Cancer
Adjuvant Radioactive Iodine Therapy Is Associated With Improved Survival for Patients With Intermediate-Risk Papillary Thyroid Cancer
复制标题
DOI：
10.1210/jc.2014-4332
复制
发表时间：
2015-04-01
影响因子：
5.8
通讯作者：
Sosa, Julie Ann
中科院分区：
文献类型：
--
作者：
Ruel, Ewa;Thomas, Samantha;Sosa, Julie Ann
背景：甲状腺乳头状癌（PTC）是最常见的内分泌恶性肿瘤。长期预后一般很好。由于缺乏数据，关于辅助放射性碘治疗（RAI）对中危PTC患者的益处存在争议。目的：本研究的目的是检查RAI对中危PTC患者总生存率的影响。设计/设置：1998-2006年国家癌症数据库中接受甲状腺全切除术伴/不伴RAI的中危PTC成人患者，患者：研究中包括由美国甲状腺协会风险和美国癌症联合委员会疾病分期T3、N 0、M0或Mx以及T1-3、N1、M0或Mx定义的中等风险患者。主要结果测量：使用单变量和多变量回归分析测量了接受和不接受RAI治疗的患者的总生存期（OS）。结果：共纳入21 870例患者; 15 418例（70.5%）接受RAI治疗，6452例（29.5%）未接受RAI治疗。平均随访6年，最长随访14年。在未校正的分析中，RAI与所有患者的OS改善相关（P < .001），在45岁以下（n = 12 612，P = .002）和65岁及以上（中位数OS 140 vs 128个月，n = 2122，P = .008）患者的亚组分析中，RAI与OS改善相关。在对人口统计学和临床因素进行多变量调整后，RAI与死亡风险降低29%相关，危险风险为0.71（95%置信区间为0.62-0.82，P <0.001）。对于年龄小于45岁的患者，RAI与死亡风险降低36%相关，危险风险为0.64（95%置信区间为0.45-0.92，P = 0.016）。结论：这是第一项关于中危PTC患者和RAI治疗的全国代表性研究，证明了RAI与总生存率改善相关。我们建议这类患者应考虑接受RAI治疗。
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, M0or 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.