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| 分化型甲状腺癌放射性碘治疗后的长期脑血管死亡率 |
| Long-term cerebrovascular mortality after radioactive iodine treatment for differentiated thyroid cancer |
| 投稿时间：2024-11-22 修订日期：2025-01-14 |
| DOI： |
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| 中文关键词: 分化型甲状腺癌 放射性碘治疗 脑血管疾病死亡率 |
| 英文关键词:differentiated thyroid cancer radioactive iodine treatment cerebrovascular disease mortality |
| 基金项目:国家自然科学基金项目（82172804）；吴阶平医学基金会（320.6750.2021-10-52） |
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| 中文摘要: |
| 目的 通过回顾性研究探讨放射性碘 (radioactive iodine, RAI) 治疗与脑血管疾病死亡率 (cerebrovascular disease mortality, CeVM) 之间的关系。方法 使用美国国家癌症研究所的监测、流行病学和最终结果 (Surveilance, Epidemiology and End Results Program, SEER)数据库,进行回顾性队列研究,纳入了1992-2020年期间诊断为非转移性分化型甲状腺癌 (differentiated thyroid cancer, DTC) 的95,616例患者,根据是否接受RAI分为两组。在1:1倾向评分匹配后,通过Kaplan-Meier曲线分析随访15年内或超过15年后癌症特异性死亡率和CeVM。继而对联合SEER 12和SEER 8数据库的队列进行多变量Cox回归分析。结果 在随访的前15年内,RAI组的CeVM较非RAI组低(P = 0.01),随访时间超过15年后,RAI组的CeVM较非RAI组高 (P = 0.03)。DTC特异性死亡率前15年内RAI组较高 (P < 0.001),但在随访超过15年后,两组之间无显著差异 (P = 0.81)。此外,联合队列多因素分析显示,随访时间大于15年时,RAI组发生CeVM的风险更高(风险比= 1.61,95%可信区间[1.28,2.02])。年龄较大、男性、美洲印第安人/阿拉斯加原住民、亚洲/太平洋岛民以及1995年以前确诊的患者也有更高的风险。结论 接受RAI治疗的DTC患者在诊断后15年内发生CeVM的风险较低,而大于15年随访后发生CeVM的风险较高。这一发现可能有助于DTC患者脑血管事件或死亡的长期管理。 |
| 英文摘要: |
| Objective A retrospective study was conducted to estimate the association between radioactive iodine (RAI) and cerebrovascular disease mortality (CeVM) in long-term follow-up. Methods We conducted retrospective cohort studies using the National Cancer Institute"s Surveillance, Epidemiology, and End Results (SEER) database. A total of 95,616 patients diagnosed with nonmetastatic differentiated thyroid cancer (DTC) during 1992-2020 were included and divided into two groups based on whether they received RAI therapy. After 1:1 propensity score matching, Kaplan-Meier curves were used to analyze cancer-specific mortality and CeVM within 15 years of follow-up or beyond. Subsequently, multivariate Cox regression analysis was performed on the combined cohort from the SEER 12 and SEER 8 databases. Results The CeVM was lower in the RAI group during the first 15 years (P = 0.01) but higher after prolonged follow-up (P = 0.03). Cancer-specific mortality of DTC was higher in the RAI group during the first 15 years (P < 0.001) and similar after prolonged follow-up (P = 0.81). Furthermore, multivariate analysis in the combined cohort showed that when follow-up time was longer than 15 years, RAI group had a higher risk of CeVM (Hazard Ratio = 1.61, 95% confidence interval [1.28, 2.02]). Older patients, males, American Indian/Alaska Native, Asian/Pacific Islander and patients diagnosed before 1995 also had a higher risk. Conclusion DTC patients who received RAI treatment underwent a lower risk of CeVM during the first 15 years after diagnosis, whereas a higher risk after more than 15 years of follow-up. This finding may help for the long-term management of cerebrovascular events or death for DTC patients. |
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