Clinical Feature,Influencing Factors Of ¹³¹I Treatment,and Prognostic Factors In Patients With Differentiated Thyroidcancer And Distant Metastases

Objective The incidence of differentiated thyroid cancer?DTC?continues to rise year by year.Distant metastatic?DM?spread is the most frequent cause of thyroid cancer-related death.Early diagnosis and treatment of DTC distant metastasis are important factors affecting the prognosis of patients.¹³¹I therapy is the main method for distant metastasis of DTC,especially for diffuse metastatic patients.¹³¹I treatment efficacy,influencing factors and patient prognosis analysis can provide effective an effective method for the patient's treatment options.This study was divided into the following three parts,Part one: the clinical data of1026 cases of DTC patients?including 115 cases of DTC patients with distant metastasis?were comparative analyzed,we summarized the clinical characteristics of DTC distant metastasis.Part two: in this syudy,retrospectively analyzed the clinical data and therapeutic effect of 98 patients with distant metastasis of DTC,and discussed the therapeutic effect and influencing factors of ¹³¹I in DTC distant metastasis.Part three: 115 cases of DTC distant metastasis of clinical data and long follow-up results were collected to analyze disease progression-free survival rate,and screen the impact of disease progression.Patients and Methods1.Post-operative DTC patients who underwent ¹³¹I treatment from August 2008 to December 2016 in our department were retrospective analyzed.Exclusion criteria:patients with incomplete clinical and pathological information.Finally,1026 patients were selected.The sex,age,pathologic type,T stage?tumor size and invasion?,lymph node metastasis?N0,N1 a,N1b?were collected.2.98 patients with DTC received multiple ¹³¹I treatment for distant metastasis between August 2008 and June 2016 in our department were analyzed.Collected patients ¹³¹I treatment data,through the corresponding efficacy evaluation criteria to observe the treatment effect,CR and PR were recognized as effective therapy.The patients were evaluated as CR and PD no longer receive continued treatment during the study.The cure rate between 1-3 times ¹³¹I theatment was compared,and the necessity of multiple ¹³¹I treatment was discussed.Logistic regression analysis was used to identify the factors that might affect ¹³¹I treatment for DTC distant metastasis.3.Long-term follow-up 115 cases with DTC distant metastasis progression-free survival were collected,compared with the patient's age??45,and < 45years?,Whether accompanied by lymph node metastasis,metastatic site?single lung,other?,metastatic size??1cm,and<1cm?,whether distant metastases uptake ¹³¹I survival curve?Kaplan-Meier?.Multivariate COX proportional hazards regression analysis was used to identify the factors affecting the progress of the disease.4.Statistical analysis.Statistical analysis was performed with SPSS 17.0 software.The prognostic value of each variable was studied by t tests,?2,Logistic regression analyses.The Kaplan-Meier model was applied to evaluate the effect of each individual variable on PFS at the last follow-up,and differences between groups were compared using log-rank test.For multivariate analysis,the Cox proportional hazards model was used to assess the relationship between survival time and several variables simultaneously.P<0.05 were considered to indicate statistically significant differences.Results1.Comparison of clinical data of DTC with DM and DTC without DM?1?1026 patients,311 males and 715 females,aged 11-89?41.6 ± 14.2?years.There were 115 cases with distant metastasis,93 cases thyroid papillary carcinoma,22 cases thyroid follicular carcinoma;36 males and 79 females,aged18-86?51.7 ± 18.5?years old.No distant metastasis was found in 911 cases,male 275 cases,female 636 cases,age 11-89?39.1 ± 15.3?years.?2?The mean age of DTC with DM patients was?51.7±18.5?,and without DM was?39.1±15.3?.The difference of age was statistically significant?t=3.018,P=0.031?.The incidence of DM between T3/T4 stage?tumor size and invasion?and T1-2 stage has statistical difference??2=47.405,P<0.001?.Lymph node metastasis?N0,N1 a,N1b?were statistically significant between distant metastasis group and non-distant metastasis group??2=8.880,P=0.003?.2.The effectiveness and influencing factors of multiple ¹³¹I treatment for DTC with DM patients?1?98 DTC with DM patients were treated with 2 or more ¹³¹I treatment.21 case were cured,58 cases were effective,and the overall effective rate is 80.61%?79/98?,19 cases were invalid.The minimum cumulative dose of 9.25 GBq,the maximum cumulative dose of 49.95 GBq,and the average dose of 23.13 GBq.Patients were treated between at least 2 times and 8 times.After 1-3 times ¹³¹I therapy,the cure rate was 7.14%?7/98?,16.33%?16/98?,and 19.39%?19/98?,respectively,with statistical significance??2=6.500,P=0.039?.?2?Mono-factor analysis.The analysis results of metering data were as follows:the average age of effective group?41.8±16.9?,and the invalid group?59.3±19.5?,The difference of age was statistically significant?t=3.832,P=0.002?.The serum Tg level of effective group and the invalid group were respectively?62.26±17.61?and?138.03±30.28?ng/ml,and the difference was statistically significant?t=6.156,P<0.001?.By chi-square test metastatic size,metastatic site,pathological type,and distant metastases revealed by first time Rx-WBS was statistically significant defference between effective and ineffective group?P=0.001,0.031,0.028,0.004?,respectively.?3?Multiple factors regression analysis.The 6 factors were introduced into Binary Logistic regression analysis.The results showed that age,metastatic size,metastatic site,Tg level,and distant metastases revealed by first time ¹³¹I Rx-WBS have significantly impact on distant metastatic DTC response to ¹³¹I.The regression equation was as follow:logit P =2.159+2.756*distant metastases detectable on the first post-ablative Rx-WBS +3.263* metastatic site?lung-only?-2.291*Tg level-2.271*size distant metastases-1.934*Age.3.The analysis of the progression-free survival rate and factors affecting progression of DTC with DM patients?1?DTC distant metastases were found as the starting point,the metastatic progress was the end point,the average follow-up time of 4.5±3.8 years?median3.5 years?.During the follow-up period,37 cases?29.56%,37/115?were progression.?2?Progression-free survival of the patient's age??45 years and <45 years?,metastatic site?lung-only,other?,metastatic size??1cm and <1cm?,whether the metastases uptake ¹³¹I were researched.The log-rank test revealed that there was a significant difference in the patient's age,metastatic site,metastatic size,and whether the metastases uptake ¹³¹I.P value was?0.030,<0.001,0.031,0.001?,respectively.?3?Patient's age??45 years and <45 years?,metastatic site?lung-only,other?,metastatic size??1cm and <1cm?,and whether the metastases uptake ¹³¹I were introduced into multivariate Cox proportion hazard regression analysis,the results indicated that metastatic site?RR=0.280,95%CI 0.119-0.659,P=0.004?,and whether distant metastases uptake 131I?RR=2.189,95%CI 1.048-4.571,P=0.037?were associated with disease progression.Conclusions1.The incidence of distant metastases in patients with DTC was about 11.2%,and metastases were often found in the lungs and bones.Older?> 45 years old?,tumor stage T3 / T4 and lateral neck lymph node metastasis should be alert to distant metastasis.Rx-WBS / SPECT-CT is an effective method for finding distant metastases.2.The present study indicates that ¹³¹I therapy is an effective therapeutic option for functioning distant metastatic DTC,and the overall cure rate increase gradually in a limited times.Complete and partial remission were achieved in most of the patients with small distant metastases,yonger,lung metastases,lower serum Tg level,and distant metastases were detectable by first time post-¹³¹I therapy WBS.¹³¹I treatment,although there is no clear dose limit,taking into account the side effects of ¹³¹I treatment and re-treatment withdrawal TSH increased the stimulation of hyperplasia of the role of PTC metastases,¹³¹I multiple treatment should be carried out on with caution.3.Most patients with DTC distant metastases can be effectively controlled by standard treatment.Metastatic site,and whether distant metastases uptake ¹³¹I predicted for disease progression.