The outcome of I-131 ablation therapy for intermediate and high-risk differentiated thyroid cancer using a strict definition of successful ablation
The outcome of I-131 ablation therapy for intermediate and high-risk differentiated thyroid cancer using a strict definition of successful ablation
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DOI：
10.1007/s11604-017-0660-9
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发表时间：
2017-09-01
影响因子：
2.1
通讯作者：
Fukuda, Kunihiko
中科院分区：
文献类型：
--
作者：
Watanabe, Ken;Uchiyama, Mayuki;Fukuda, Kunihiko
本文回顾性分析了91例高危甲状腺癌患者放射性碘消融治疗的结果，并调查了影响消融失败的背景因素，评估了消融成功率。成功消融定义为全身扫描后甲状腺床中没有可见的碘-131（I-131）蓄积，且消融后TSH刺激状态下甲状腺球蛋白水平< 2 ng/ml。我们提取了患者的年龄、性别、I-131剂量、病理学、切除残端所见、肿瘤T分类和甲状腺球蛋白水平等可能影响消融结果的数据，仅14例（15.4%）成功消融。消融失败组术前血清甲状腺球蛋白水平显著高于消融成功组（P < 0.001），其他各项指标两组间差异无显著性。此外，多变量分析后，甲状腺球蛋白水平> 10 ng/ml与消融失败显著相关（比值比27.2; 95%置信区间2.469-299.7; P = 0.007）。高风险患者，尤其是甲状腺球蛋白水平高（> 10 ng/ml）的患者，不太可能达到足够低的水平以满足成功消融标准。
This article examines the outcome of radioactive iodine ablation therapy for thyroid cancer in high-risk patients and investigates background factors influencing ablation failure.We included 91 patients in this retrospective analysis and evaluated the ablation success rate. Successful ablation was defined as the absence of visible iodine-131 (I-131) accumulation in the thyroid bed after whole-body scans and thyroglobulin levels < 2 ng/ml in a TSH-stimulated state after ablation. We extracted data on patients' age, sex, I-131 dose, pathology, resection stump findings, tumor T category and thyroglobulin levels, which could affect ablation outcome.Successful ablation was achieved in only 14 patients (15.4%). Pre-ablation serum thyroglobulin levels were significantly higher in the ablation failure group than in the success group (P < 0.001), while no significant differences were found for other factors between the groups. Furthermore, thyroglobulin levels > 10 ng/ml were significantly related to ablation failure after multivariate analysis (odds ratio 27.2; 95% confidence interval 2.469-299.7; P = 0.007).The ablation success rate was very low because of high thyroglobulin levels, even with high-dose I-131. High-risk patients, especially those with high thyroglobulin levels (> 10 ng/ml), are unlikely to reach levels low enough to meet successful ablation criteria.