CAJ | 학술논문

目的评价131I治疗DTC肺转移的疗效,并分析影响疗效的相关因素.方法回顾性分析2007年10月至2012年12月间接受131I治疗的50例DTC肺转移患者[男18例,女32例,平均年龄(40.8±13.2)岁],治疗后6个月以Tg结合131I显像等评价131I疗效,对可能影响疗效的年龄、性别、DTC术式、病理学类型、确诊肺转移时间、确诊时Tg水平、摄131I形态、其他影像学检查发现、颈部淋巴结转移和肺外远处转移(有转移赋值1,无转移赋值0)等10个因素进行单因素(独立样本t检验及Fisher确切概率法)和多因素分析(logistic回归).结果 131I治疗DTC肺转移的治愈率为20％(10/50),有效率74％ (37/50),无效率26％ (13/50).单因素分析结果显示:患者年龄(t=2.019,P＜0.05)、性别(P=0.032)、确诊肺转移时Tg水平(t=2.646,P＜0.05)、其他影像学检查发现(P=0.039)及肺外远处转移(P=0.023)5个因素与疗效相关;进一步的多因素分析结果显示:患者年龄、确诊肺转移时Tg水平以及肺外远处转移是影响131I治疗DTC肺转移的确定性因素.回归方程:Logit P=2.127-0.056×年龄-0.163×Tg水平-1.280×肺外远处转移(x2=10.484,P＜0.001).患者年龄越大、确诊肺转移时Tg水平越高以及合并肺外远处转移,131I治疗DTC肺转移的疗效越差.结论 131I治疗DTC肺转移疗效确切;DTC肺转移患者中,年龄轻、确诊时Tg水平低以及无肺外远处转移的患者131I治疗效果好.
목적 평개131I치료DTC폐전이적료효,병분석영향료효적상관인소.방법 회고성분석2007년10월지2012년12월간접수131I치료적50례DTC폐전이환자[남18례,녀32례,평균년령(40.8±13.2)세],치료후6개월이Tg결합131I현상등평개131I료효,대가능영향료효적년령、성별、DTC술식、병이학류형、학진폐전이시간、학진시Tg수평、섭131I형태、기타영상학검사발현、경부림파결전이화폐외원처전이(유전이부치1,무전이부치0)등10개인소진행단인소(독립양본t검험급Fisher학절개솔법)화다인소분석(logistic회귀).결과 131I치료DTC폐전이적치유솔위20％(10/50),유효솔74％ (37/50),무효솔26％ (13/50).단인소분석결과현시:환자년령(t=2.019,P＜0.05)、성별(P=0.032)、학진폐전이시Tg수평(t=2.646,P＜0.05)、기타영상학검사발현(P=0.039)급폐외원처전이(P=0.023)5개인소여료효상관;진일보적다인소분석결과현시:환자년령、학진폐전이시Tg수평이급폐외원처전이시영향131I치료DTC폐전이적학정성인소.회귀방정:Logit P=2.127-0.056×년령-0.163×Tg수평-1.280×폐외원처전이(x2=10.484,P＜0.001).환자년령월대、학진폐전이시Tg수평월고이급합병폐외원처전이,131I치료DTC폐전이적료효월차.결론 131I치료DTC폐전이료효학절;DTC폐전이환자중,년령경、학진시Tg수평저이급무폐외원처전이적환자131I치료효과호.
Objective To investigate the efficacy and influential factors of 131I treatment for lung metastases from DTC.Methods Fifty patients (18 males,32 females;age (40.8±13.2) years) with lung metastases from DTC who underwent 131I treatment from October 2007 to December 2012 were retrospectively analyzed.The efficacy of 131 I treatment was assessed using 131I imaging and determination of serum Tg level after 6 months.The possible factors affecting efficacy included patients' age,gender,operation method,pathological classification,the diagnostic time of pulmonary metastasis,serum Tg level at diagnosis,131I uptake pattern,characteristics of other imaging modalities,cervical lymph node metastases and extrapulmonary distant metastases (assign 1 for metastases,0 for no metastases).Univariate and multivariate analyses (Student t test,Fisher exact test and logistic regression) were performed to investigate the factors.Results The rates of complete remission,partial response and invalid of 131I treatment were 20％ (10/50),74％ (37/50) and 26％ (13/50) respectively.Univariate analysis showed that age(t =2.019,P＜0.05),gender (P =0.032),serum Tg level at diagnosis (t =2.646,P＜ 0.05),findings of other imaging modalities (P =0.039),and extrapulmonary distant metastases(P=0.023) were the factors influencing outcome of 131I treatment.Multivariate logistic regression analysis showed that the influential factors included age,serum Tg levels and extrapulmonary distant metastases.The regression equation was as follows:logit P =2.127-0.056× age-0.163×Tg level-1.280×extrapulmonary distant metastasis (x2=10.484,P＜0.001).Aged patients,a significant increase of Tg level and extrapulmonary distant metastases indicated a poor prognosis.Conclusions 131I treatment is an effective method for lung metastases from DTC.The patients with younger age,lower Tg levels,no other distant metastases had good response to 131I treatment.