Effectiveness assessment of surgical resection combined with 131Ⅰ therapy on differentiated thyroid carcinoma in the elderly / 中华老年医学杂志

ABSTRACT

Objective:To explore the clinical value of surgical resection combined with 131Ⅰ therapy in the treatment of differentiated thyroid carcinoma(DTC)in the elderly. Methods:From January 2010 to December 2015, 168 elderly patients with DTC admitted to the general surgery department of our hospital were divided into the combined treatment group(n=97)and the surgery group(n=71). During the same period, 68 young and middle-aged patients with DTC were enrolled as the control group.The combined treatment and control groups were treated with total or subtotal thyroidectomy combined with 131Ⅰ therapy, while the surgery group received surgical resection only.An enzyme-linked immunosorbent assay(ELISA)was used to monitor the thyroglobulin(Tg)level of patients in the three groups before and 1 week after treatment and 1, 3, 6 months after treatment, and adverse reactions and clinical efficacy grading within 6 months after treatment were evaluated.Tumor recurrence and metastasis and patient survival in the three groups were followed up for 5 years. Results:After 1 month of treatment, serum Tg levels showed significant differences between the three groups( F=15.329, P=0.011), and Tg levels were lower in the control group than in the combined treatment and surgery groups[(30.47±6.97) μg/L vs.(47.13±7.34) μg/L, (46.12±6.55) μg/L, t=3.462 and 4.791, P=0.017 and 0.023)]. After 3 and 6 months of treatment, serum Tg levels still had significant differences between the three groups( F=22.641 and 34.182, P=0.000 and 0.000), and Tg levels were lower in the combined treatment and control groups than in the surgery group[(28.27±10.16) μg/L, (41.82±9.83) μg/L vs.(13.17±2.69), t=3.164 and 4.649, P=0.012 and 0.005; (11.16±5.43) μg/L, (28.67±9.19) μg/L vs.(1.45±0.28) μg/L, t=4.251 and 7.283, P=0.009 and 0.000)], and the control group had lower Tg levels than the combined treatment group( t=2.184 and 4.537, P=0.011 and 0.000). After 6 months of treatment, the incidences of myelosuppression(21.6%, 0.0% vs.11.8%, χ2=17.851, P=0.000)and gastrointestinal reaction(37.1%, 11.3% vs.27.9%, χ2=14.070, P=0.001)were higher in the combined treatment group than in the surgery and control groups.The control group had a higher rate of effectiveness than the other two groups(73.5% vs.62.9%, 31.0%, χ2=8.796 and 33.834, P=0.032 and 0.000)and the combined treatment group had a higher effectiveness rate than the surgery group, (62.9% vs.31.0%, χ2=18.825, P=0.000). During the follow-up, the tumor recurrence-free time and the survival time were better in the control group than in the other two groups( Log Rankχ2=30.335 and 20.628, P=0.000 and 0.000). Conclusions:Surgical resection combined with 131Ⅰ therapy can reduce local progression, recurrence and metastasis of DTC, but its clinical effectiveness is worse in elderly patients than in young and middle-aged patients.