Analysis Of Risk Factors And Therapeutic Response Of ¹³¹I Therapy For Lung Metastases In Patients With Differentiated Thyroid Carcinoma

PART Ⅰ Analysis of risk factors of lung metastases in patients with differentiated thyroid carcinomaObjective: The purpose of the study was to analysis of risk factors of pulmonary metastasis in patients with differentiated thyroid carcinoma.The high-risk patients with pulmonary metastasis tendency were given risk warning and prompt,so as to diagnose DTC pulmonary metastasis early,take active intervention measures,and improve the clinical benefit rate of patients.Methods: We retrospectively analyzed the clinical data of 253 patients with DTC who received standardized treatment in the Department of Nuclear Medicine of Wuhan Union Hospital from October 2018 to November 2019 and with complete medical records,including 46 patients with lung metastasis.Lung metastasis was confirmed by pathological results,¹³¹I-whole body scan(¹³¹I-WBS),s Tg,and positive imaging results of CT or chest X-ray.The data from all patients with gender,age,BMI,the interval time from neck nodules founded to the first operation,Interval between surgery and primary radioiodine treatment（RAIT）time,primary tumor site,primary tumor pathological type,single or multiple lesions,the maximum diameter of tumor,the sum of diameters of all the lesions,vascular invasion,thyroid capsular invasion,cervical lymph node metastasis,the number of cervical lymph node metastasis,thyroid associated disease and other clinical information was collected and sorted out.The data were analyzed using statistical product and service solutions（SPSS）26.0 software.Results: Of all the 253 patients,46 cases with lung metastases.There were 84 male patients and 169 female patients（male: female =1:2）.The Patients were aged 9-71 years old.Pathological classification showed there were 229 CPTC,19 cases of FV-PTC,and 5 cases of FTC.Univariate analysis showed that BMI,pathological type,maximum tumor diameter,the sum of diameters of all the lesions,the number of cervical lymph node metastasis,thyroid capsule invasion,thyroid associated disease were significant factors for lung metastasis（p<0.05）.Through Multivariate logistic regression analysis we can conclude that BMI,pathological type and the number of cervical lymph node metastases were independent risk factors（p<0.05）.Conclusions: DTC patients with BMI>24kg/m²,pathological types of FV-PTC and FTC,and more cervical lymph node metastases had a higher risk of lung metastasis.Therefore,attention should be paid to the relevant clinical information in the process of clinical treatment and follow-up.If the patients have the risk factors of lung metastasis mentioned above,relevant clinical examinations should be actively carried out to identify lung metastasis,so as to improve the quality of life of the patients.PART Ⅱ Analysis of the therapy response and Influencing factors to 131I treatment in lung metastases of differentiated thyroid cancerObjective: The relevant clinical data of radioactive iodine therapy were analyzed to find the influencing factors associate with the response to 131I therapy for lung metastasis of differentiated thyroid cancer.Methods: We retrospectively analyzed 138 patients with lung metastasis of differentiated thyroid cancer who were treated in our department from January 2014 to June 2019.The clinical data including gender,age,BMI,Interval between surgery and primary radioiodine treatment（RAIT）time,primary tumor site,primary tumor pathological type,single or multiple lesions,the maximum diameter of tumor,the number of cervical lymph node metastasis,vascular invasion,thyroid capsular invasion,thyroid associated disease,the diameter of metastatic foci,metastases uptake iodine ability,stimulated thyroglobulin level before the first time of 131 I therapy（s Tg）were collected.According to the DTC treatment response evaluation system of ATA guidelines（2015）,combined with patients’ clinical manifestations,imaging results,and biochemical indicators,the treatment response of patients with DTC with pulmonary metastases was assessed.The clinical characteristics and indicators of patients with ER and patients without ER（BIR / IDR / SIR）were compared the clinical factors associated with better treatment response were identified.Results: Radioactive iodine is an effective treatment for patients with lung metastases from DTC.Most patients can benefit from 131 I treatment.Primary focal bigger than 2 cm,diameter of metastases in the lungs more than 1cm,Poor iodine uptake capacity of metastases,Patients with s Tg≥62.7 μg/L before the first treatment had poor response to 131 I treatment.The DTC patients who with the above characteristics should pay attention to evaluate the efficacy of radioactive iodine treatment and adjust the frequency of treatment and follow-up in time.Conclusions: Radioiodine treatment for patients with pulmonary metastases of DTC has beneficial therapeutic effect.Patients with primary lesions beyond 2 cm,lung metastases beyond 1 cm,poor iodine uptake capacity of metastases,and s Tg≥62.7 μg/L before first treatment to 131 I therapy.Patients with lung metastases of thyroid cancer who have the above characteristics should pay attention to evaluating the efficacy of radioiodine therapy and promptly adjusting the treatment modality and frequency of follow-up.