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題名 | Papillary Thyroid Cancer with Chest Metastases Only Detected Using Radioactive Iodine=僅能以碘131掃描偵測到肺部轉移的甲狀腺乳突癌 |
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作者 | 郭昇峰; 陳思達; 高潘福; 張祐銓; 周碩麒; 林仁德; | 書刊名 | 長庚醫學 |
卷期 | 27:9 2004.09[民93.09] |
頁次 | 頁663-672 |
分類號 | 415.931 |
關鍵詞 | 碘131核子掃描; 肺部轉移; 甲狀腺乳突癌; Papillary thyroid cancer; Chest metastases; [fef3]I scintigraphy; |
語文 | 英文(English) |
中文摘要 | 背景:有些甲狀腺乳突癌病人的肺部轉移能以碘131偵測到,但胸部X光檢查卻無變化,討論這類病人預後因子的相關文獻並不多,本研究試圖探討這些病人臨床表現的特徵及碘131之療效。 方法:此回顧性研究是針對1985年至2002年在本院治療的甲狀腺乳突癌病人。共有17位病人胸部X光檢查正常,卻能以碘131偵測到肺部轉移。若以碘攝取的型態可進一步將這些病人分為瀰漫性肺部轉移,以及局部性的肺部或縱膈腔轉移兩組。吾人以此比較其臨床特性及對碘131治療的反應,同時以最後一次追蹤的結果將病人分為已治療及持續檢出肺部轉移兩組,再從中分析影響其預後之因子。 結果:17位病人之平均年齡為32.2[]19.1歲。經過89.6[]51.3個月的追蹤,除了1位病人死於非甲狀腺疾病,其餘16位病人均存活。這17位病人中,有6位病人已無疾病的跡象,另外有8位病人的肺部轉移消失。比較經碘131治療後肺部攝取消失者的臨床發現,呈現瀰漫性肺部轉移的病人,所需要的碘131治療劑量比呈現局部肺部或縱膈腔轉移的病人為高。已治癒和持續肺部轉移兩組病人之血中甲狀腺球蛋白濃度及原發腫瘤的大小有顯著差異。 結論:碘131全身掃瞄能早期發現X光及電腦斷層偵測不出的肺部轉移。只能以碘131偵測到肺部或縱膈腔轉移的甲狀腺乳突癌病患,其預後佳。除此之外,血中甲狀腺球蛋白濃度較低以及原發腫瘤較小可能有較佳之預後。 |
英文摘要 | Backgorund: Insufficient information exists on the prognostic factors of papillary thyroid cancer (PTC) with chest metastases, which is detected only using a radioactive iodide (131I) whole body scan (WBS) but could not be detected using radiographic findings. The aim of this study was to analyze the clinical features and treatment results of patients with PTC. Methods: This retrospective study includes 17 patients diagnosed from 1985 through 2002. The clinical features and responses to treatment were compared between patients with diffuse lung metastases and those with focal lung or mediastinal metastases, and at the end of follow up the results were also compared between disease-free patients and those with persistent chest metastases. Results: The mean age of the 17 patients was 32.2[]19.1 years. After a mean follow up of 89.6[]51.3 months, all 17 patients survived except for one who died of a non-thy-roid-related disease. Six of the 17 patients were disease-free at the end of follow up, and eight of the 17 patients became free of chest metastases. The dose of 131I required to cure chest metastases was higher in the patients with diffuse lung uptake than those with focal chest uptake. The primary tumor size and serum thyroglobulin (Tg) level on the first finding of chest metastases differed markedly between disease-free patients and patients with persistent chest metastases. Conclusions: 131I scans can effectively demonstrate early chest metastases, which are difficult to detect from chest X-ray or computed tomography (CT). The prognosis for patients with papillary thyroid carcinoma with chest metastases detectable only using 131I is favorable. Additionally, the low serum Tg level on the first finding of chest metastases and the small size of the primary tumor may have favorable therapeutic outcomes. |
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