肽受体放射性核素疗法治疗分化型甲状腺癌的 Meta 分析。

Peptide Receptor Radionuclide Therapy in Patients With Differentiated Thyroid Cancer: A Meta-analysis.

机构信息

From the Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

出版信息

Clin Nucl Med. 2020 Aug;45(8):604-610. doi: 10.1097/RLU.0000000000003110.

DOI:10.1097/RLU.0000000000003110

PMID:32520503

Abstract

PURPOSE

As patients with progressive medullary thyroid cancer (MTC) and radioiodine-refractory metastatic differentiated nonmedullary thyroid cancer (DTC) have poor prognoses and present therapeutic challenges, peptide receptor radionuclide therapy (PRRT) targeting the somatostatin receptor provides a promising option. This meta-analysis evaluated the therapeutic effects and outcomes of PRRT in differentiated thyroid cancer.

PATIENTS AND METHODS

PUBMED, EMBASE, CINAHL, SCOPUS, and COCHRANE were systematically searched using appropriate key words. The primary therapeutic effect was the radiological response after PRRT, and the objective response rate (ORR) and disease control rate (DCR) were identified in MTC and DTC, respectively. The outcome of serious adverse events (grade 3 or 4), additional therapeutic effects of F-FDG PET/CT and biochemical (calcitonin and thyroglobulin) responses, and radionuclides for PRRT were assessed as subgroup analyses. The parameters were generated as pooled proportions.

RESULTS

Eleven articles with 165 patients were included (98 patients with MTC and 67 patients with DTC). PRRT achieved pooled proportions of ORR in 8.53% to 15.61%, DCR in 53.95% to 59.99%, and serious adverse events in 2.79% to 2.82% in MTC and DTC patients. F-FDG PET/CT and biochemical responses revealed similar results as the radiological response. Lu-based PRRT (ORR, 11.48%-24.52%; DCR, 61.47%-67.26%) showed better therapeutic effects than Y-based PRRT (ORR, 6.98%-13.82%; DCR, 50.86%-57.29%).

CONCLUSIONS

This meta-analysis suggests that PRRT could be a potential and safe strategy for MTC and DTC. In particular, PRRT with Lu exhibited improved therapeutic effects relative to PRRT with Y.

摘要

目的

患有进展性髓样甲状腺癌（MTC）和放射性碘难治性分化型非髓样甲状腺癌（DTC）的患者预后较差，且存在治疗挑战，因此针对生长抑素受体的肽受体放射性核素治疗（PRRT）提供了一种有前途的选择。本荟萃分析评估了 PRRT 在分化型甲状腺癌中的治疗效果和结果。

方法

系统检索了 PUBMED、EMBASE、CINAHL、SCOPUS 和 COCHRANE 数据库，使用了适当的关键词。主要治疗效果是 PRRT 后的影像学反应，在 MTC 和 DTC 中分别确定了客观缓解率（ORR）和疾病控制率（DCR）。评估了严重不良事件（3 级或 4 级）、F-FDG PET/CT 和生化（降钙素和甲状腺球蛋白）反应的附加治疗效果以及 PRRT 的放射性核素的结果，作为亚组分析。参数生成了汇总比例。

结果

纳入了 11 篇文章的 165 名患者（98 名 MTC 患者和 67 名 DTC 患者）。PRRT 在 MTC 和 DTC 患者中的 ORR 汇总比例为 8.53%至 15.61%，DCR 为 53.95%至 59.99%，严重不良事件为 2.79%至 2.82%。F-FDG PET/CT 和生化反应与影像学反应显示出相似的结果。基于 Lu 的 PRRT（ORR，11.48%-24.52%；DCR，61.47%-67.26%）比基于 Y 的 PRRT（ORR，6.98%-13.82%；DCR，50.86%-57.29%）具有更好的治疗效果。