131I treatment for thyroid cancer and the risk of developing salivary and lacrimal gland dysfunction and a second primary malignancy: a nationwide population-based cohort study
131I treatment for thyroid cancer and the risk of developing salivary and lacrimal gland dysfunction and a second primary malignancy: a nationwide population-based cohort study
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DOI：
10.1007/s00259-015-3055-0
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发表时间：
2015-07-01
影响因子：
9.1
通讯作者：
Yen, Ruoh-Fang
中科院分区：
文献类型：
--
作者：
Ko, Kuan-Yin;Kao, Chia-Hung;Yen, Ruoh-Fang
目的本研究的目的是确定唾液腺和泪腺功能障碍和第二原发性恶性肿瘤的患病率从台湾甲状腺癌患者放射性碘therapy.Methods这个全国范围内的人群为基础的队列研究是基于从台湾国民健康保险数据库2000年至2011年获得的数据。共招募了1，834名接受I-131治疗的甲状腺癌患者和1，834名对照（未接受I-131治疗的甲状腺癌），这些患者通过倾向评分1：1匹配进行选择。计算每例患者的累积I-131剂量。应用考克斯比例风险模型估计I-131治疗对唾液腺和泪腺损害以及第二原发恶性肿瘤风险的影响，其风险比（HR）和95%置信区间（CI）。唾液腺功能障碍的发生率分别为6.76/万人年和1.01/万人年（HR6.81，95%CI0.74 ~ 55.3），干燥性角结膜炎（KCS）的发病率分别为13.6和16.3/万人年（HR 0.84，95% CI 0.41 - 1.73），第二原发性恶性肿瘤的发生率分别为76.7和62.4/10，000人-年（HR 1.23，95% CI 0.88 - 1.72）。唾液分泌障碍的风险随着给药剂量的增加而显著增加（HR 14.3，95% CI 1.73 - 119.0）。然而，有没有增加KCS或继发性癌症的发病率在患者接受较高dose.Conclusion I-131治疗的风险增加不显着的唾液腺功能障碍和第二原发性恶性肿瘤。在累积剂量较高的患者中，观察到唾液腺功能障碍的发生率增加。相比之下，我们没有发现I-131治疗和KCS发展之间的关联。
Objective The aim of this study was to determine the prevalence of salivary and lacrimal gland dysfunction and a second primary malignancy in patients from Taiwan with thyroid cancer after radioiodine therapy.Methods This nationwide population-based cohort study was based on data obtained from the Taiwan National Health Insurance Database from 2000 to 2011. A total of 1,834 thyroid cancer patients treated with I-131 therapy and 1,834 controls (thyroid cancer without I-131 therapy) selected by 1:1 matching on a propensity score were enrolled. The cumulative I-131 dose in each patient was calculated. A Cox proportional hazards model was applied to estimate the effect of radiation from the I-131 therapy on the risk of salivary and lacrimal gland impairment as well as second primary malignancies in terms of hazard ratios (HRs) and 95 % confidence intervals (CIs).Results In patients treated with I-131 therapy and in controls, the incidence rates of salivary gland dysfunction were 6.76 and 1.01 per 10,000 person-years, respectively (HR 6.81, 95 % CI 0.74 - 55.3), the incidence rates of keratoconjunctivitis sicca (KCS) were 13.6 and 16.3 per 10,000 person-years, respectively (HR 0.84, 95 % CI 0.41 - 1.73), and the incidence rates of second primary malignancy were 76.7 and 62.4 per 10,000 person-years, respectively (HR 1.23, 95 % CI 0.88 - 1.72). The risk of salivary secretion impairment significantly increased with increasing administered doses (HR 14.3, 95 % CI 1.73 - 119.0). However, there was no increase in the incidence of KCS or secondary cancer in patients treated with higher doses.Conclusion I-131 therapy insignificantly increased the risk of salivary gland dysfunction and second primary malignancy. In patients with higher cumulative doses, an increase in the incidence of salivary gland dysfunction was observed. By contrast, we did not find an association between I-131 treatment and KCS development.