Efficacy and Survival Analysis of 131I Therapy for Bone Metastases from Differentiated Thyroid Cancer
Efficacy and Survival Analysis of 131I Therapy for Bone Metastases from Differentiated Thyroid Cancer
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DOI：
10.1210/jc.2011-0093
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发表时间：
2011-10-01
影响因子：
5.8
通讯作者：
Luo, Quan-Yong
中科院分区：
文献类型：
--
作者：
Qiu, Zhong-Ling;Song, Hong-Jun;Luo, Quan-Yong
目的：探讨碘-131治疗分化型甲状腺癌(DTC)骨转移的临床疗效和预后因素，评估患者的生存状况和影响生存的因素。方法：对106例DTC骨转移患者进行回顾性分析。根据血清甲状腺球蛋白(TG)的变化、骨痛的缓解情况和骨病变的解剖影像变化来评价治疗效果。结果：经I-131治疗后，37例(34.9%)患者血清甘油三酯显著下降，56例(52.8%)患者血清甘油三酯稳定。61例骨转移疼痛患者中，39例骨痛明显缓解，有效率为63.9%。大多数DTC患者(76.4%)在I-131治疗后骨转移灶无明显的解剖影像改变。仅组织学类型和是否合并非骨性远处转移对血清TG的变化有统计学意义(P=0.009和0.023)，年龄>45岁和乳头状癌对解剖影像的变化有较好的反应(P=0.027和0.014)。5年和10年生存率分别为86.5%和57.9%。多因素分析显示，单发骨转移、单纯骨转移和I-131治疗与预后相关(P=0.024、0.009和0.031)。结论：I-131治疗是一种可行、有效的治疗方法。在I-131治疗前有单一转移灶、仅有骨转移或接受骨手术的患者预后较好。(临床内分泌代谢酶96：3078-3086,2011)
Objective: Our objective was to investigate the clinical efficacy of I-131 therapy for bone metastases from differentiated thyroid cancer (DTC) and prognostic factors as well as to assess patient survival and variables influencing survival.Methods: One hundred six DTC patients with bone metastases treated with I-131 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.Results: After I-131 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 I-131 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 I-131 therapy with previous bone surgery were independent factors associated with a better prognosis (P = 0.024, 0.009, and 0.031).Conclusion: I-131 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 I-131 therapy. (J Clin Endocrinol Metab 96: 3078-3086, 2011)