| Part 1 Study on Risk Factors for Affecting 131I Treatment on Cervical Lymph Node Metastasis of Papillary Thyroid CarcinomaObjectiveThe purpose of this study was to analyze the therapeutic effect of 131I on papillary thyroid carcinoma(PTC)with cervical lymph node metastasis(LNM)and the main factors affecting the curative effect.MethodsA retrospective analysis of 1,403 cases of PTC patients who were consecutively treated between January 2014 and December 2016 at our department was performed.All of the patients were confirmed as PTC by surgery and pathology.Therefore,432 patients were ultimately included in the study.Variance analysis,chi-square test and rank sum test were used to compare these different groups.Multinominal logistic regression was adopted in adjusting the same covariates.ResultsIn the final group of 432 patients,at a mean follow-up of 22(6-41)months,168 cases were classified as excellent response(ER,38.89%),50 cases were classified as biochemical incomplete response(BIR,11.57%),133 cases were classified as structural incomplete response(SIR,30.79%),and 81 cases were classified as indeterminate response(IDR,18.75%).Univariate analysis had statistical significance would be accepted for multivariate logistic regression analysis.Final result showed that the size of the metastatic focus in a lymph node,iodine uptake capacity of LN metastases,primary foci maximum diameter and primary foci soft tissue invasion were independent risk factors for SIR and BIR,respectively.Multivariate logistic regression analysis showed that the maximum diameter of metastatic LN foci,iodine uptake capacity of LN metastases,the maximum diameter of primary foci and thyroid soft tissue invasion were four independent risk factors which were related to the efficiency of 13 131I treatment on lymph node metastases.Further,the larger the metastatic focus in a LN,the more likely it was to induce SIR(P<0.05,OR 3.311,CI:1.783-6.150).In addition,as compared with patients with non-absorbing capacity of LNs,the risk of structural incomplete remission increased to 2.197 times and biochemical incomplete remission increased to 2.939 times for patients with iodine-absorbing lesions.The risk of structural incomplete remission in patients with thyroid soft tissue invasion was 4.426 times higher than those patients without thyroid soft tissue invasion.Every 1cm rise in the maximum diameter of primary foci,the risk of BIR incresed to 1.594 times for patients.By comparing the fitting effects and prediction effects of the model,it is found that the model with the maximum diameter of metastatic lymph node foci is better than the model with the maximum diameter of metastatic lymph node.ConclusionIn summary,131I is an effective method for the treatment of cervical lymph node metastases in the PTC.size of the largest metastatic focus to the LN,iodine uptake capacity of metastatic lymph nodes,primary foci maximum diameter and primary foci soft tissue invasion are independent risk factors for the efficacy of 131I treatment of PTC with lymph node metastasis.The size of the largest metastatic focus to the LN is not equal to the maximum diameter of metastatic LN.In clinical practice,the two variables should be distinguished and can not be confused.Compared with the maximum diameter of metastatic LNs,the maximum diameter of metastatic LN foci was more intuitive to predict the efficacy of 131I.It is important to evaluate the above risk factors in clinical practice to establish more standardized management and treatment of patients.Part 2 Analysis of Curative Effect of 131I Treating Cervical Lymph Node Metastasis of Papillary Thyroid MicrocarcinomaObjectiveTo analyze the differences between the clinicopathological distribution characteristics of papillary thyroid microcarcinoma(PTMC)and non-PTMC with lymph node metastases(LNM),and also analyse the therapeutic effect of 131I treatment on PTMC with LNM and the main factors for affecting its curative effect.MethodsThe clinical data of 106 cases of PTMC with LNM and 309 cases of non PTMC with LNM were collected and the clinicopathological distribution characteristics of two groups were compared.The efficacy evaluation was based on the 2015 American Thyroid Association(ATA)guide.A separate observation on clinicopathologic factors for influencing the therapeutic effect of PTMC was performed.The statistical analysis adopted the chi-square test and Multivariate logistic regression analysis.ResultsAmong the 106 cases of PTMC patients,52 cases were classified as excellent response(ER,49.06%),5 cases were biochemical incomplete response(BIR,4.72%),27 cases were structural incomplete response(SIR,25.47%),and 22 cases were indeterminate response(IDR,20.75%).In the 309 cases of non PTMC patients,129 cases were ER(41.7%),53 cases were BIR(17.2%),58 cases were SIR(18.8%),and 69 cases were IDR(22.3%).The pathological and clinical distribution of PTMC with lymph node metastases were similar to those with non PTMC with lymph node metastasis,and there was no statistical difference between the therapeutic effect of 1311 and non PTMC with lymph node metastases(x2=3.484,P=0.062).Multivariate logistic regression analysis of 131I treatment on PTMC with LNM showed:thyroid soft tissue invasion is a independent risk factors for the efficacy of 131I treatment of PTMC with lymph node metastasis.ConclusionThe pathological,clinical distribution and remission rate of PTMC with lymph node metastases are similar to those with non PTMC with lymph node metastasis,so the treatment of PTMC with lymph node metastasis should be the same as non-PTMC.Thyroid soft tissue invasion is a independent risk factors for the efficacy of 131I treatment of PTMC with lymph node metastasis. |
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