| 陈 鑫,俞佳敏,狄文忆,等.基于SEER数据库的分化型甲状腺癌放射性碘治疗后长期脑血管疾病死亡率分析[J].肿瘤学杂志,2025,31(2):108-115. |
| 基于SEER数据库的分化型甲状腺癌放射性碘治疗后长期脑血管疾病死亡率分析 |
| Long-Term Mortality of Cerebrovascular Disease in Patients with Differentiated Thyroid Cancer After Radioactive Iodine Treatment： A Study Based on SEER Database |
| 投稿时间：2024-11-22 |
| DOI：10.11735/j.issn.1671-170X.2025.02.B004 |
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| 中文关键词: 甲状腺肿瘤 放射性碘 脑血管疾病 死亡率 随访 |
| 英文关键词:thyroid neoplasms radioactive iodine cerebrovascular disease mortality follow-up |
| 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: |
| 摘 要：［目的］ 探讨放射性碘（radioactive iodine，RAI） 治疗与分化型甲状腺癌（differentiated thyroid cancer，DTC）患者脑血管疾病死亡率（cerebrovascular disease mortality，CeVM） 的关系。［方法］ 基于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1992—2020年期间诊断为非转移性DTC的95 616例患者，根据是否接受RAI分为两组（RAI组44 595例，非RAI组51 021例）。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年的 DTC特异性死亡率和CeVM。并对联合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=0.010），而随访时间超过15年后，RAI组的CeVM较非RAI组高（P=0.027）。两组的DTC特异性死亡率在前15年内无显著性差异（P=0.430），但在随访时间超过15年后，RAI组较高（P=0.011）。此外，联合SEER 12和SEER 8数据库的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（HR=1.61，95%CI：1.28~2.02，P=0.037），且年龄较大、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CeVM。［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，而超过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: |
| Abstract： ［Objective］ To explore the relationship between radioactive iodine (RAI) treatment and cerebrovascular disease mortality (CeVM) among patients with differentiated thyroid cancer (DTC). ［Methods］ A retrospective cohort study was conducted using the National Cancer Institute’s Surveillance， Epidemiology， and End Results Program (SEER). A total of 95 616 patients with nonmetastatic DTC during 1992—2020 were included， there were 44 595 cases who received RAI(RAI group) and 51 021 cases who did not receive RAI(non-RAI group). After 1∶1 propensity score matching(PSM)， cancer-specific mortality and CeVM within 15 years of follow-up or beyond was analyzed by Kaplan-Meier curves. Subsequently， multivariate Cox regression analysis was performed on the combined cohort from the SEER 12 and SEER 8 databases. ［Results］ During the first 15 years of follow-up， the CeVM in the RAI group was lower than that in the non-RAI group (P=0.010)， while after more than 15 years of follow-up， the CeVM in the RAI group was higher than that in the non-RAI group (P=0.027). There was no significant difference in cancer specific mortality of DTC between the two groups within the first 15 years (P=0.430)， but after follow-up for more than 15 years， the RAI group had a higher cancer specific mortality (P=0.011). 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 (HR=1.61， 95%CI： 1.28~2.02， P=0.037)， and older patients， American Indian/Alaska Native， Asian/Pacific Islander and patients diagnosed before 1995 also had a higher CeVM. ［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 be conducive to the long-term management of cerebrovascular events or death for DTC patients. |
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