[1]孟召伟 ?宋兴华 谭建 张桂芝 何雅静 贾强 张富海 王任飞 郑薇 李雪 张建萍.不同放射性活度I131清除分化型甲状腺癌患者残留甲状腺的荟萃分析[J].国际内分泌代谢杂志,2015,(01):16-21.[doi:10.3760/cma.j.issn.1673-4157.2015.01.004]
　Meng Zhaowei,Song Xinghua,Tan Jian,et al.Different activities of 131I for remnant thyroid ablation in patients with differentiated thyroid cancer: a meta analysis[J].International Journal of Endocrinology and Metabolism,2015,(01):16-21.[doi:10.3760/cma.j.issn.1673-4157.2015.01.004]
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不同放射性活度I131清除分化型甲状腺癌患者残留甲状腺的荟萃分析()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
期数:
2015年01
页码:
16-21
栏目:
荟萃分析
出版日期:
2015-01-20

文章信息/Info

Title:
Different activities of 131I for remnant thyroid ablation in patients with differentiated thyroid cancer: a meta analysis
作者:
孟召伟 ?宋兴华 谭建 张桂芝 何雅静 贾强 张富海 王任飞 郑薇 李雪 张建萍
300052 天津医科大学总医院核医学科
Author(s):
Meng Zhaowei; Song Xinghua; Tan Jian; Zhang Guizhi; He Yajing; Jia Qiang; Zhang Fuhai; Wang Renfei; Zheng Wei; Li Xue; Zhang Jianping.
Department of Nuclear Medicine,The General Hospital,Tianjin Medical University,Tianjin 300052,China
关键词:
分化型甲状腺癌; 131I; 清除残留甲状腺; 随机对照试验
Keywords:
Differentiated thyroid cancer;  131I; Remnant thyroid ablation; Randomized controlled trial
DOI:
10.3760/cma.j.issn.1673-4157.2015.01.004
摘要:
目的 使用荟萃分析方法汇总所有的随机对照研究，比较不同放射性活度131I清除术后残留甲状腺（清甲）的成功率，明确最佳的清甲剂量。方法 以‘thyroid’+‘cancer or carcinoma’+ ‘ablat$’（包括了ablation、ablative和ablate）为关键词检索2014年3月前Cochrane Library、MEDLINE、EMBASE和SCOPUS等数据库评估不同放射性活度131I清甲成功率的随机对照研究文献，并用Google学术查找相关文献。用RevMan 5.2进行统计学分析，依据Cochrane质量评价标准进行文献质量评估。纳入标准如下：（1）已发表的比较不同剂量131I对分化型甲状腺癌（DTC）清甲成功率的研究。（2）患者均行甲状腺切除术。（3）均为术后首次131I治疗。（4）服131I后3~12个月行清甲成功率评估。（5）服131I剂量为888～4 440 MBq（24~120 mCi）。本研究定义低剂量为888～1 443 MBq（24~39 mCi)、中剂量为1 480～2 923 MBq（40~79 mCi)、高剂量为2 960～4 440 MBq（80~120 mCi）。当研究间存在异质性时（I2>50%）、采用随机效应模型进行荟萃分析，否则采用固定效应模型进行荟萃分析。 结果 共纳入17个随机对照研究，包括3 737例患者（低剂量1 514例、中剂量811例、高剂量1 412例）。5项研究比较了低剂量与中剂量的成功率，研究间有异质性（I2=67%，P=0.02）、采用随机效应模型，荟萃分析结果显示两组的清甲成功率差异无统计学意义［风险比（RR）=0.89（0.80～1.00），P=0.06］。7项研究比较了中剂量与高剂量的成功率，研究间无异质性（I2=34%，P=0.17），采用固定效应模型，荟萃分析结果显示两组剂量的清甲成功率差异无统计学意义［RR=0.94（0.89～1.00），P=0.05］。11项研究比较了低剂量与高剂量的成功率，研究间有异质性（I2=70%，P=0.000 2），采用随机效应模型，荟萃分析结果显示高剂量的清甲成功率显著高于低剂量［RR=0.89（0.81～0.97），P=0.008］。 结论 对于术后DTC患者，低剂量与中剂量131I以及中剂量与高剂量131I的清甲成功率无明显差异，但高剂量131I的清甲成功率显著高于低剂量。
Abstract:
Objective To compare the successful rate of different activities of 131I for postoperative remnant ablation in randomized controlled trials (RCTs), and determine the optimal dose with a meta analysis. Methods Sources were retrieved from the Cochrane Library, MEDLINE, EMBASE, SCOPUS and Google Scholar until March 2014. The search strategy included the terms:′thyroid′ +′cancer or carcinoma′ + ′ablat$′ (to cover ablation, ablative and ablate).All RCTs that assessed the efficacy of different doses of 131I for ablation were selected. Statistics were performed by Review Manager 5.2 software. The risk of bias and quality in each eligible study was assessed by Cochrane′s risk of bias tool. Studies were included for analysis if they met the following criteria:(1) RCTs were published as articles that compared the efficacy of different dose 131I in ablation of differentiated thyroid cancer (DTC).(2) patients had undergone thyroidectomy.(3) patients were treated with 131I for the first time after surgery.(4) assessed the successful remnant ablation at 3 to 12 months after 131I administration.(5) 131I activity was less than 4 440 MBq (120 mCi) and more than 888 MBq (24 mCi). We defined low dose as from 888 to 1 443 MBq(24-39 mCi), moderate dose as from 1 480 to 2 923 MBq (40-79 mCi), and high dose as from 2 960 to 4 440 MBq (80-120 mCi). Statistical heterogeneity between studies was assessed by means of I2 value.A fixe deffect model was used for calculations unless significant heterogeneity existed (I2>50%), in which case a randomeffect model was used. Results BZ〗Seventeen RCTs were considered eligible, involving 3 737 patients (1 514 low dose, 811 moderate dose and 1 412 high dose). Five trials compared low versus moderate dose activities. Heterogeneity was found (I2=67%,P=0.02), and the random effect model was used. This analysis showed no significant difference in successful rate of thyroid remnant ablation［risk ratio ( RR)=0.89 (0.80 to 1.00), P=0.06］. Seven trials compared moderate versus high dose activities. No heterogeneity was found (I2=34%,P=0.17), and the fixed effect model was used. This analysis also showed no significant difference ［RR=0.94(0.89 to 1.00),P=0.05］. Eleven trials compared low versus high dose activities. Heterogeneity was found (I2=70%,P=0.000 2), and the randomeffect model was used. The successful rate of thyroid remnant ablation of high dose was statistically significant higher than that of low dose［RR=0.89(0.81 to 0.97), P=0.008］. Conclusions There is no significant difference in successful rate of thyroid remnant ablation between low and moderate dose treatment, or moderate and high dose treatment in patients after DTC operation. However, high dose is significantly better than low dose.

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备注/Memo

备注/Memo:
（收稿日期：2014-10-08）
更新日期/Last Update: 2015-03-20