JAMA:放射性碘治疗甲状腺功能亢进症后的癌症风险

2021-10-22 从医路漫漫 MedSci原创

放射性碘(RAI)治疗甲状腺功能亢进症(甲亢)是否会增加癌症风险在医学和公共卫生领域仍是一个有争议的问题。

重要性:放射性碘(RAI)治疗甲状腺功能亢进症(甲亢)是否会增加癌症风险在医学和公共卫生领域仍是一个有争议的问题。

目的:研究甲状腺功能亢进症(甲亢)RAI治疗后特定部位癌症发病率和死亡率,并评价放射剂量-反应关系。

数据来源:Medline和Cochrane图书馆电子数据库,使用医学主题词条和文本关键字,Embase,使用Emtree,筛选到2020年10月。

研究选择:纳入标准如下:(1)纳入接受RAI治疗的甲亢患者,并随访至癌症诊断或死亡;(2)纳入至少1个由未接受RAI治疗的个人(例如,普通人群或接受甲状腺切除或抗甲状腺药物治疗的甲亢患者)或接受不同剂量RAI治疗的甲亢患者组成的对照组;(3)纳入效应大小衡量标准(即标准化发病率[SIR]、标准化死亡率[SMR]、风险比[HR]),以及(3)纳入效应大小测量(即标准化发病率[SIR]、标准化死亡率[SMR]、风险比[HR]),以及(3)纳入效应大小测量(即标准化发病率[SIR]、标准化死亡率[SMR]、[HR])。

数据提取与分析:两名独立研究人员根据流行病学观察性研究的Meta分析(MOOSE)指南提取数据。全面质量评估遵循了联合国原子辐射影响科学委员会的建议。采用随机效应荟萃分析对SIR和SMRs、RRs和HRs进行合并。

主要结果和措施:暴露于RAI治疗与不暴露于RAI治疗的癌症发病率和死亡率以及RAI治疗活动度的水平。

结果:基于12项研究(包括479452名参与者)的数据,暴露于RAI治疗与不暴露于RAI治疗的总体癌症合并发病率比为1.02(95%CI,0.95-1.09),合并癌症死亡率比为0.98(95%CI,0.92-1.04)。除甲状腺癌发病率(SIR,1.86;95%CI,1.19-2.92)和死亡率(SMR,2.22;95%CI,1.37-3.59)外,其他特定癌症增加的风险均无统计学意义。然而,无法控制适应症和其他偏倚来源的混淆是比较RAI暴露和非暴露的研究的重要限制。根据2项研究,在剂量-反应分析中,RAI与乳腺癌和实体癌死亡率显著相关(乳腺癌死亡率,每370MBq:1.35;P=0.03;实体癌死亡率,每370MBq:1.14;P=0.01)。

表1 甲状腺功能亢进放射性碘治疗后癌症风险发生率和死亡率的meta分析

表2 调节因子与甲状腺机能亢进症放射性碘治疗后总体癌症风险的关系

图 放射性碘剂量与癌症死亡率的线性和非线性模型的剂量-效应关系

结论和相关性:在这项荟萃分析中,暴露于RAI治疗与不暴露后的整体合并癌症风险没有显著性差异,但RAI治疗与实体癌死亡率之间存在线性剂量反应相关性。这些发现表明,RAI治疗甲状腺机能亢进症后辐射诱发癌症的风险很小,而且在观察性研究中,可能只有在较高的给药剂量时才能检测到。

原文出处

Shim SR,  Kitahara CM,  Cha ES,et al.Cancer Risk After Radioactive Iodine Treatment for Hyperthyroidism: A Systematic Review and Meta-analysis.JAMA Netw Open 2021 Sep 01;4(9)

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