CAJ | 학술논문

目的评价131I治疗DTC骨转移的疗效及影响因素,评估生存率及其影响因素.方法回顾分析经131I治疗的106例DTC骨转移患者的临床资料,分别基于131I治疗后血清Tg的变化、骨痛缓解情况和影像学变化评价131I治疗疗效,并对影响131I疗效的因素进行单因素分析;采用寿命表法评估DTC骨转移患者的131I治疗后总生存率;采用Kaplan-Meier法对影响生存率的因素进行分析,应用Log-rank法比较各组间差异.结果经131I 治疗后血Tg显著下降者37例,有效率34.9%.骨转移伴疼痛的61例DTC经131I治疗后疼痛明显缓解者39例,有效率63.9%.患者年龄、病理类型、是否合并其他非骨性远端转移等因素对131I 治疗后血Tg的变化有影响(χ2=6.443,11.455和6.756,P均<0.05),但对131I 治疗后骨痛缓解的影响无统计学意义(χ2=0,0,0.060,P均>0.05).131I治疗后77.4%的患者骨转移灶无明显影像学变化.该组DTC骨转移患者5年和10年生存率分别为86.47%和57.90%;骨转移灶数目、是否合并其他远端脏器转移、131I治疗前是否行手术治疗对患者的10年生存率影响差异有统计学意义(Log-rank值为4.05,5.98和4.22,P均<0.05);患者的性别、年龄、病理类型、是否以骨转移症状首诊等因素对10年生存率无明显影响(Log-rank值为0.01,1.56,2.59和0.04,P均>0.05).结论 131I治疗可使DTC骨转移患者血清Tg下降、骨痛缓解、病灶保持稳定或缩小,是治疗DTC骨转移的有效手段;单发病灶、单纯骨转移、手术+131I治疗患者预后较好.
목적 평개131I치료DTC골전이적료효급영향인소,평고생존솔급기영향인소.방법 회고분석경131I치료적106례DTC골전이환자적림상자료,분별기우131I치료후혈청Tg적변화、골통완해정황화영상학변화평개131I치료료효,병대영향131I료효적인소진행단인소분석;채용수명표법평고DTC골전이환자적131I치료후총생존솔;채용Kaplan-Meier법대영향생존솔적인소진행분석,응용Log-rank법비교각조간차이.결과 경131I 치료후혈Tg현저하강자37례,유효솔34.9%.골전이반동통적61례DTC경131I치료후동통명현완해자39례,유효솔63.9%.환자년령、병리류형、시부합병기타비골성원단전이등인소대131I 치료후혈Tg적변화유영향(χ2=6.443,11.455화6.756,P균<0.05),단대131I 치료후골통완해적영향무통계학의의(χ2=0,0,0.060,P균>0.05).131I치료후77.4%적환자골전이조무명현영상학변화.해조DTC골전이환자5년화10년생존솔분별위86.47%화57.90%;골전이조수목、시부합병기타원단장기전이、131I치료전시부행수술치료대환자적10년생존솔영향차이유통계학의의(Log-rank치위4.05,5.98화4.22,P균<0.05);환자적성별、년령、병리류형、시부이골전이증상수진등인소대10년생존솔무명현영향(Log-rank치위0.01,1.56,2.59화0.04,P균>0.05).결론 131I치료가사DTC골전이환자혈청Tg하강、골통완해、병조보지은정혹축소,시치료DTC골전이적유효수단;단발병조、단순골전이、수술+131I치료환자예후교호.
Objective To evaluate the efficacy of 131I treatment for bone metastases from DTC and analyze the survival rates after 131I treatment and prognostic factors. Methods One hundred and six DTC patients with bone metastases treated by 131I during January 1991 and January 2009 were retrospectively analyzed. Treatment efficacy was assessed based on serum Tg change, bone pain palliation and changes on medical imaging. Univariate analysis was performed for defining the factors affecting 131I treatment efficacy. Survival curves were estimated using the life table method. Survival analysis was performed using Kaplan-Meier method. Results Serum Tg decreased dramatically in 37/106 (34.9%) patients treated with131I. Thirty-nine of 61 patients (63.9%) with bone pain had pain relief. Age, tumor subtype and presence of non-osseous distant metastases were significant factors affecting 131I treatment efficacy based on serum Tg change (χ2=6.443, 11.455, 6.756, all P<0.05), but had no significant effects on bone pain palliation (χ2=0, 0, 0.060, all P>0.05). There were no imaging changes of bone metastases in 77.4% of patients after 131I treatment. The overall 5-year and 10-year survival rates from initial diagnosis of bone metastases was 86.47% and 57.90%, respectively. Univariate analysis showed that number of metastases, presence of non-osseous distant metastases and pre-131I treatment surgery were significant factors for survival (Log-rank values were 4.05, 5.98, 4.22, all P<0.05). Conclusions 131I treatment for bone metastases from DTC is effective for lowering serum Tg and palliation of bone pain. Single metastasis, absence of non-osseous distant metastases and pre-131I therapy surgery are favorable predictors of prognosis.