Dynamic Evaluation Of Therapeutic Effect Of 131I On Differentiated Thyroid Carcinoma And Its Influencing Factors

Objective This research adopts the new reaction system,through the dynamic evaluation of patients with differentiated thyroid carcinoma?DTC?after ¹3131 I treatment for 3 months,6 months,1 year and 2 years of treatment response and its change,analysis of different clinical pathological characteristics,recurrence risk stratification and TNM staging response relationship between therapeutic effect and explore the clinical pathological features to achieve the best treatment response?ER?and the influence of the ER cumulative risk,through the ROC curve evaluation of pathological characteristics of ER predictive value;The clinical significance and value of the new response system for DTC evaluation after ¹³¹I treatment were described.Methods Patients who underwent total or near-total thyroidectomy in the affiliated hospital of Qingdao university from January 2014 to October 2017 and were confirmed to be DTC by postoperative pathology with only lymph node metastasis,TGAb negative and¹³¹I treatment were selected.?1?Basic clinicopathological data of the patients were collected,such as age,gender,BMI,pathological type,number of cancer foci,maximum diameter,number of single/bilateral,lymph node metastasis,homozygous/bilateral,partition,whether the patient had extra-capsular invasion and complicated HT;¹³¹I times,¹³¹I first treatment dose,total dose;The risk stratification and TNM stage of recurrence were evaluated.Thyroid stimulating hormone?TSH?,thyroglobulin?Tg?,anti-thyroglobulin antibody?TGAb?levels before and after¹³¹I treatment,as well as imaging results of¹³¹I whole-body imaging,SPECT/CT fusion imaging,neck ultrasound,chest and abdominal CT,etc.?2?To analyze the correlation between the post-treatment response of DTC¹³¹I and the clinicopathological features;?3?To evaluate the predictive value of DTC clinicopathological features for optimal therapeutic response?ER?;?4?Assess the cumulative risk of DTC clinicopathological features in predicting non-er;?5?To analyze the correlation between treatment response after DTC 131I and follow-up time,risk stratification of recurrence and TNM stage.Results There were only 423 patients with DTC accompanied by lymph node metastasis,among whom 351?82.97%?had no lymph node metastasis before treatment?surgical resection?and 72?17.03%?still had lymph node metastasis.?1?Treatment response after2 years of treatment with ¹³¹I was divided into ER group and non-er group,and the clinicopathological characteristics of the two groups were compared.The results showed that the ratio of female,single foci,primary cancer foci diameter?1cm,combined HT,no extra capsule invasion and no lymph node metastasis before ¹³¹I in ER group was significantly higher than that in non-er group,with statistically significant differences?all P<0.05?.There was no significant difference in age,BMI and primary focus between the two groups?all P>0.05?.In the number of metastatic lymph nodes,metastasis rate,location and subdivision groups,the number of lymph node metastasis??4,median?,the rate of lymph node metastasis??40%,median?,ipsilateral metastasis and cervical region metastasis in the ER group were higher than those in the non-er group,with statistically significant differences?all P<0.05?.In the treatment times and dose groups of ¹³¹I,the ER rate of group 1 was higher than that of group 2 and group?3,respectively,with statistically significant differences?all P<0.017?,while there was no significant difference between group 2 and group?3?P>0.017?.The ER rate of the group with the first dose of¹³¹I?100?50-100?mCi was significantly higher than that group of>100?120-180?m Ci,and the difference was statistically significant?P<0.05?.The ER rate of the group with the total dose of ¹³¹I of 50-100 mCi was significantly higher than that of the group with the total dose of 101-150 mCi than that of the group with the total dose of 101-150 mCi was significantly higher than that of the group with the total dose of 101-150 mCi than that of the group with the total dose of 101-150 mCi was significantly higher than that of the group with the total dose of 101-150 mCi than that of the group with the total dose of>200?201-600?mCi,with statistically significant differences?all P<0.008?.In the ps-Tg value group,the proportion of low level ps-Tg??3.87 ng/mL?in the ER group was significantly higher than that in the high level?>3.87 ng/m L?,and the difference was statistically significant?P<0.05?.In the relapse risk stratification and TNM staging groups,the proportion of low-risk and stage I/II patients in the ER group was higher than that in the non-er group,with statistically significant differences?all P<0.05?.Multi-factor analysis showed that:the cancer small diameter?1 cm OR less?,single stove,combined HT,lymph node metastasis rate is low?40%?OR less and less 131I?1?,131I before without lymph node metastasis,the low level of ps-Tg?3.87 ng/m L?OR less in order to promote to achieve the best treatment response?ER?independent impact factors?OR=1.744,3.114,0.256,4.018,49.491,2.074,9.767,P<0.05?.?2?Combined HT with the HT group comparison between the two groups,the results showed that HT group of women,BMI 25kg/m2 or less,the capsule invasion ratio is significantly higher than the HT group,the difference had statistical significance?P<0.05?,the number and age,primary lung cancer,the primary focal single/double side,primary lung cancer are focal diameter,number of lymph node metastasis,transfer rate,transfer/double side,¹3131 I former presence of lymph node metastasis had no statistical significance?P>0.05?.Multi-factor analysis showed that female and non-capsular invasion were independent influencing factors of DTC with HT?OR=2.739,2.102,all P<0.05?.?3?The predictive value of different clinicopathological features in achieving optimal response?ER?was analyzed respectively,and the results showed that:The areas under the ROC curve for the number of lymph node metastases,lymph node metastasis rate,tumor diameter,and ps-Tg value to achieve the optimal response to the prediction?ER?were 0.641,0.746,0.725,and 0.821,respectively.The critical values were 6,50.50%,1.900 cm,and 4.625 ng/mL,respectively.The sensitivity was 57.8%,63.3%,60.60%,84.4%,and the specificity was 65.3%,79.6%,73.9%,and67.8%,respectively.Positive predictive values were 80.8%,86.2%,84.36%,92.6%,and negative predictive values were 39.4%,51.8%,44.59%,and 48.7%,respectively.?4?Respectively different malignant pathological features two addition,calculating the cumulative risk of ER,the results showed:?1?When the ps-Tg respectively and diameter,number of cancer,cancer,lymph node metastasis number and transfer rate,regardless of the low ps-Tg level?3.75 ng/mL?or less,or high ps-Tg levels?>3.75 ng/mL?group,as cancer diameter,number of cancer,the increase in the number of lymph node metastasis and the transfer rate,two two joint group of ER cumulative risk were significantly increased,and the high level joint group is significantly higher than low level joint,differences were statistically significant?all P<0.05?;?2?When lymph node metastasis rate was combined with the diameter of the tumor,the cumulative risk of non-er increased significantly with the increase of the diameter of the tumor in both the low level??40%?group and the high level?>40%?group,and the difference was statistically significant?P<0.05?.?3?When the diameter of cancer was combined with the number of cancer foci,the cumulative risk of non-er increased significantly with the increase of the number of cancer foci in both the group with the diameter?1 cm and the group with the diameter of>1 cm,and the combined group with the diameter of>1cm was higher than the combined group with the diameter?1cm,the difference was statistically significant?P<0.05?.?5?The dynamic change of treatment response and the analysis of the relationship with the follow-up time,risk stratification of recurrence and TNM staging showed that,among the 250 patients initially evaluated as ER,8?3.2%?were converted to IR,2?0.8%?to BIR,and 1?0.4%?to SIR during the 2-year follow-up.Among the 82patients initially evaluated as IR,52?63.41%?were converted to ER,5?6.09%?to BIR,and 3?3.65%?to SIR.Of the 88 patients initially evaluated as BIR,22?25%?were converted to ER,24?27.27%?to IR,and 13?14.77%?to SIR.Among the 3 patients initially evaluated as SIR,1?33.33%?changed to ER and 1?33.33%?to BIR.ER rate and SIR rate were strongly positively correlated with the follow-up time,while IR rate and BIR rate were strongly negatively correlated with the follow-up time?all P<0.05?.There was a weak negative correlation between ER rate and recurrence risk stratification,and a weak positive correlation between BIR rate and SIR rate and recurrence risk stratification?all P<0.05?.ER rate and IR rate were weakly negatively correlated with TNM stage,while BIR rate and SIR rate were weakly positively correlated with TNM stage?all P<0.05?.Conclusion?1?ER rate of 74.23%2 years after DTC ¹³¹I,small tumor diameter??1cm?,single foci,no lymph node metastasis before combined HT and¹³¹I,low lymph node metastasis rate??40%?,low frequency of¹³¹I?1 time?and low level of ps-Tg??3.87ng/mL?were independent influencing factors for optimal response?ER?.?2?Tumor diameter,lymph node metastasis rate and ps-Tg value are good indicators to predict ER.?3?Ps-Tg and the diameter,number of cancer foci,number of lymph node metastasis,metastasis rate,diameter of cancer foci,lymph node metastasis rate and number of cancer foci were added in pairs to increase the cumulative risk of non-er.?4?ER rate was positively correlated with follow-up time,weakly negatively correlated with recurrence risk stratification and TNM stage.IR rate was negatively correlated with follow-up time,of which 63.41%were converted to ER.