不同剂量131I治疗中低危分化型甲状腺癌的短期疗效及长期预后的Meta分析

Efficacy and prognosis after different doses of 131I treatment for differentiated thyroid cancer in low- and intermediate-risk patients: a Meta-analysis

    摘要
  • 摘要:
    目的 评价中低危分化型甲状腺癌（DTC）患者不同剂量131I治疗后的短期疗效及长期预后的差异。
    方法 检索 PubMed、EMBASE、Cochrane Library、中国知网、万方数据库等数据库中关于DTC患者131I治疗后短期疗效及长期预后评估的文献，检索时间均为自建库至2022年9月。根据纳入和排除标准筛选文献。应用RevMan 5.4软件进行Meta分析。采用相对危险度（ RR）及其 95%置信区间（CI）对二分类数据进行效应统计量描述。采用χ2检验和I2值对文献进行异质性评价。
    结果 最终纳入7篇文献，共2754例患者，其中低剂量组（1.1~2.2 GBq）1452例、高剂量组（3.7 GBq）1302例。（1）低剂量组和高剂量组131I治疗后短期疗效的差异无统计学意义（RR=0.93，95%CI：0.86~1.01，P=0.07）。对地区欧洲（RR=0.95，95%CI：0.90~1.01，P=0.08）；亚洲（RR=0.86，95%CI：0.68~1.08，P=0.20）、术式甲状腺全切除术（TT）（RR=0.78，95%CI：0.49~1.23，P=0.28）；甲状腺近全切除术（NTT） （RR=0.97，95%CI：0.93~1.01，P=0.15）、危险度分层中低危（RR=0.92，95%CI：0.83~1.01，P=0.08）；低危（RR=0.98，95%CI：0.83~1.14，P=0.76）、治疗前TSH刺激方式甲状腺激素戒断（THW）（RR=0.90，95%CI：0.79~1.02，P=0.11）；THW/外源性补充重组人促甲状腺激素（RR=0.96，95%CI：0.90~1.03，P=0.23）及清甲成功定义标准甲状腺球蛋白（Tg）水平Tg<10 ng/ml（RR=0.94，95%CI：0.86~1.03，P=0.20）；Tg<2 ng/ml（RR=0.85，95%CI：0.68~1.05，P=0.13）； Tg<1 ng/ml（RR=0.96，95%CI：0.84~1.11，P=0.61）等做进一步分析，结果显示，各亚组间的差异均无统计学意义。（2）低剂量组和高剂量组131I治疗后长期预后的差异无统计学意义（RR=0.93，95%CI：0.58~1.49，P=0.77）。对术式TT（RR=1.09，95%CI：0.28~4.21，P=0.80）；NTT（RR=0.88，95%CI：0.52~1.50，P=0.63）、危险度分层中低危（RR=2.00，95%CI：0.50~7.94，P=0.32）；低危（RR=0.83，95%CI：0.50~1.37，P=0.46）及随访时间<5年（RR=0.45，95%CI：0.10~2.02，P=0.30）；≥5年（RR=1.03，95%CI：0.60~1.75，P=0.93） 、<10年（RR=1.00，95%CI：0.56~1.76，P=0.99）；≥10年（RR=0.80，95%CI：0.35~1.82，P=0.54）的进一步分析结果显示，各亚组间的差异均无统计学意义。（3）低剂量组和高剂量组后续131I治疗的差异有统计学意义（RR=1.61，95%CI：1.33~1.95，P<0.001）。
    结论 低剂量和高剂量131I治疗中低危DTC后的短期疗效及长期预后的差异均无统计学意义；低剂量131I治疗的患者更有可能因为残留甲状腺或持续性/复发性疾病而进行≥ 2次的131I治疗。

     

    Abstract:
    Objective To evaluate the short-term efficacy and long-term prognosis of patients with low- and intermediate-risk differentiated thyroid cancer (DTC) treated with different 131I doses.
    Methods Studies on the short-term efficacy and long-term prognosis evaluation of patients with DTC after 131I treatment were searched from databases such as PubMed, EMBASE, Cochrane Library, CNKI, and Wanfang from inception to September 2022. Screening of literature was based on specific inclusion and exclusion criteria. Meta-analysis was performed with RevMan 5.4 software. Dichotomous data were compared using relative risk (RR), and 95% confidence intervals (95%CI) were calculated for each estimate. Heterogeneity was evaluated by χ2 test and I2 value.
    Results Seven studies with 2754 patients were included. The low-dose group (1.1–2.2 GBq) comprised 1452 cases, and the high-dose group (3.7 GBq) consisted of 1302 cases. (1) No significant difference in short-term efficacy (RR=0.93, 95%CI: 0.86–1.01, P=0.07) was found between the low- and high-dose groups. Further analysis showed no statistically significant difference between the subgroups of regions (Europe (RR=0.95, 95%CI: 0.90–1.01, P=0.08) and Asia (RR=0.86, 95%CI: 0.68–1.08, P=0.20)); operation modes(total thyroidectomy (RR=0.78, 95%CI: 0.49–1.23, P=0.28); and near total thyroidectomy (RR=0.97, 95%CI: 0.93–1.01, P=0.15)); risk stratification (low and intermediate risk (RR=0.92, 95%CI: 0.83–1.01, P=0.08); and low risk (RR=0.98, 95%CI: 0.83–1.14, P=0.76)); thyroid-stimulating hormone (TSH) stimulation modes (thyroid hormone withdrawal (RR=0.90, 95%CI: 0.79–1.02, P=0.11); and thyroid hormone withdrawal/recombinant human TSH (RR=0.96, 95%CI: 0.90–1.03, P=0.23)); and criteria for successful ablation (Tg<10 ng/ml (RR=0.94, 95%CI: 0.86–1.03, P=0.20), Tg<2 ng/ml (RR=0.85, 95%CI: 0.68–1.05, P=0.13), and Tg<1 ng/ml (RR=0.96, 95%CI: 0.84–1.11, P=0.61)). (2)No significant difference in long-term prognosis was observed between the low- and high-dose groups (RR=0.93, 95%CI: 0.58–1.49, P=0.77). Further analysis showed no statistically significant difference between the subgroups of operation modes (total thyroidectomy (RR=1.09, 95%CI: 0.28–4.21, P=0.80); and near total thyroidectomy (RR=0.88, 95%CI: 0.52–1.50, P=0.63)); risk stratification (low and intermediate risk (RR=2.00, 95%CI: 0.50–7.94, P=0.32); and low risk (RR=0.83, 95%CI: 0.50–1.37, P=0.46)); and follow-up time (<5 years (RR=0.45, 95%CI: 0.10–2.02, P=0.30), ≥5 years (RR=1.03, 95%CI: 0.60–1.75, P=0.93), <10 years (RR=1.00, 95%CI: 0.56–1.76, P=0.99), and ≥10 years (RR=0.80, 95%CI: 0.35–1.82, P=0.54)). (3) Significant difference in subsequent 131I treatment was found between the low- and high-dose groups (RR=1.61, 95%CI: 1.33–1.95, P<0.001).
    Conclusions No statistically significant difference in short-term efficacy and long-term prognosis was observed between low- and high-dose 131I treatments for low- and intermediate-risk DTC. Patients treated with low-dose 131I are likely to undergo ≥ 2 times of 131I treatment due to residual thyroid or persistent/recurrent diseases.

     

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