Prognostic Factors Of ¹³¹I Refractory Differentiated Thyroid Carcinoma

Objective:TC is a kind of common endocrine malignancy,and its incidence rate is increasing rapidly.DTC accounts for more than 90%of thyroid cancer,DTC has good differentiation,low malignancy and high survival rate.A small number of DTC patients have distant metastasis.About 1/3 of the patients with distant metastasis lose the ability to absorb iodine at the beginning of treatment or during treatment,and finally develop into iodine refractory DTC The 10-year survival rate of Rair-DTC is only 10%.131I treatment is an important treatment for DTC,and Rair-DTC has poor effect of iodine treatment due to the low or ectopic expression of NIS Through the retrospective analysis of the clinical data of patients with iodine refractory and non iodine refractory DTC in the nuclear medicine department of Yi Jishan Hospital of Wannan Medical College,this study explored the risk factors affecting Rair-DTC and predicted radioiodine refractory（RAIR）In order to early predict the possibility of developing rair-dtc in patients with DTC and help them choose other treatment methods early.Materials and Methods:The clinical data of differentiated thyroid cancer patients treated with iodine in the nuclear medicine department of Yi Jishan Hospital of Wannan Medical College from January 1,2017 to December 30,2020 were collected.According to the definition of Rair-DTC in the guidelines of American Thyroid Association（ATA）)in 2015,the patients were divided into iodine refractory group（RAIR）40 cases and non iodine refractory group（NRAIR）40 cases.The gender,age and primary focus（size,unilateral/bilateral,single focus/multiple focus）between the two groups were compared,pathological type,invasion of capsule,number of lymph node metastasis,distant metastasis;serum irritation TG value,TG-Ab value,TSH value level,time interval between first iodine treatment and operation,¹³¹Itimes and other factors before the first ¹³¹I treatment were analyzed.The measurement data were analyzed by t-test（mean±standard deviation）The counting data were analyzed by chi square test or Fisher exact probability test;the influencing factors with single factor statistical difference were analyzed by binary logistic regression;the value of serum s Tg level in predicting the occurrence of RAIR of DTC before treatment was analyzed by ROC curve.P<0.05 was statistically significant.Results:Univariate analysis showed that the pathological type,distant metastasis before treatment,serum s Tg level before treatment and ¹³¹Itreatment times of the two groups were statistically significant（P<0.01）.There was no significant difference between the two groups in gender,age,maximum diameter of primary tumor,single and multiple foci,single and bilateral,invasion of capsule,number of lymph node metastasis,serum TG-Ab level,serum TSH level,time interval between the first ¹³¹I treatment and operation（P>0.05）2.Binary logistic regression analysis showed that pathological type,serum STG before treatment and ¹³¹I treatment times were the predictors of Rair-DTC.3.ROC curve results show that serum STG and ¹³¹I before treatment have high accuracy in predicting Rair-DTC.When serum STG≥42.6ng/ml before treatment,the AUC of predicted RAIR was 0.737（95%CI:0.628～0.846,P<0.01）,the sensitivity was 52.5%,and the specificity was 87.5%.When ¹³¹I treatment times≥3times,the AUC of predicted RAIR was 0.873（95%CI:0.786～0.961,P<0.01）,the sensitivity was 92.5%,and the specificity was 82.5%.Conclusions:Pathological type is the predictor of ftic,high serum TG before treatment,¹³¹I treatment times and Rair-DTC.When the serum STG of DTC patients before treatment is≥42.6ng/ml and the number of ¹³¹I treatment is≥3 times,the possibility of Rair-DTC should be evaluated in time,¹³¹I treatment should be terminated as soon as possible and other treatment schemes should be adopted.