实用医学杂志 ›› 2021, Vol. 37 ›› Issue (16): 2114-2118.doi: 10.3969/j.issn.1006⁃5725.2021.16.016

• 临床研究 • 上一篇    下一篇

鼻咽癌患者经调强放疗序贯抗PD⁃1免疫治疗后甲状腺功能减退的影响因素

王瑞莲1，谭锦云2， 卢梓荣2， 刘慧2， 冯建辉2， 郑荣辉2   

  1. 1 广州市天河区石牌街华师社区卫生服务中心（广州 510631）；2 广州医科大学附属肿瘤医院（广州 510095）

  • 出版日期:2021-08-25 发布日期:2021-08-25
  • 通讯作者: 谭锦云 E⁃mail：393025526@qq.com；郑荣辉 E⁃ mail：27819000@qq.com
  • 基金资助:

    广东省科技计划项目（编号：2018B070702005）；广 州市科技计划项目（编号：201806020121） 


The influencing factors of hypothyroidism after intense⁃modulated radiotherapy and sequential anti⁃PD⁃1 immunotherapy for nasopharyngeal carcinoma

WANG Ruilian*，TAN Jinyun，LU Zirong，LIU Hui，FENG Jianhui，ZHENG Ronghui.    

  1. Community Service Center of South China Normal University，Guangzhou 510631，China

  • Online:2021-08-25 Published:2021-08-25
  • Contact: TAN Jinyun E⁃mail：393025526@qq.com；ZHENG Ronghui E⁃mail：27819000@qq.com

摘要：

目的 分析鼻咽癌患者经放疗序贯免疫治疗后甲状腺功能减退的发生率及危险因素。 方法 选取使用放射治疗及免疫治疗的鼻咽癌患者 66 例，根据是否发生甲状腺功能减退分为甲减组和非 甲减组。分析联合治疗后的甲减发生率变化，并采用多因素 logistic 回归分析筛选治疗后鼻咽癌患者甲状腺功能减退的独立危险因素。结果 66 例患者中位随访时间为 12 个月，其中 18 例（27.3%）发生不同程度 甲状腺功能减退，距放疗结束的中位时间为 19.5 个月，距免疫治疗开始的中位时间为 3 个月。鼻咽癌放疗序贯免疫治疗后甲减发生率较既往单纯放疗或免疫治疗患者升高。多因素 logistic 回归分析结果显示：有无甲状腺结节（P = 0.046）以及治疗前 LDH（P = 0.047）是鼻咽癌放疗序贯免疫治疗后甲减的独立危险因素。联合上述因素绘制的 ROC 曲线下面积（AUC）为 0.853。结论 鼻咽癌患者调强放疗序贯抗 PD⁃1 免疫 治疗后，甲状腺功能减低发生率升高。对于有甲状腺结节、治疗前 LDH 水平升高的鼻咽癌患者而言，放疗序贯免疫治疗后发生甲状腺功能减退风险明显提高。

关键词:

鼻咽癌,  , 放射治疗,  , 免疫治疗,  , 甲状腺功能减退,  , 危险因素

Abstract:

Objective To analyze the incidence and risk factors of hypothyroidism in patients with naso⁃ pharyngeal carcinoma after receiving radiotherapy and sequential immunotherapy. Methods A total of 66 patients with nasopharyngeal carcinoma who had undergone radiotherapy and immunotherapy were enrolled. According to present or absent of hypothyroidism，the patients were divided into hypothyroidism group and non⁃hypothyroidism group. Changes in the incidence of hypothyroidism were analyzed after the combined treatment. Multivariate logistic regression analysis was used to screen the independent risk factors of hypothyroidism in the patients receiving radio⁃ therapy and immunotherapy. Results The median follow⁃up time was 12 months in 66 patients. 18 patients（27.3%） developed hypothyroidism at various degrees. The median time was 19.5 months from the end of radiotherapy and 3 months from the beginning of immunotherapy. The incidence of hypothyroidism after radiotherapy combined with sequential immunotherapy for nasopharyngeal carcinoma was higher than that in the patients undergoing radiotherapy or immunotherapy alone. Multivariate logistic regression analysis showed present or absent of thyroid nodules（P = 0.046）and baseline LDH（P = 0.047）were independent risk factors of hypothyroidism after radiotherapy in combi⁃ nation with sequential immunotherapy for nasopharyngeal carcinoma. The area under the ROC curve（AUC）was 0.853. Conclusions After intensity⁃modulated radiotherapy and sequential anti⁃PD⁃1 immunotherapy for nasopha⁃ ryngeal carcinoma，the incidence of hypothyroidism increased significantly. For the patients with nasopharyngeal carcinoma who had thyroid nodules or an increase in baseline LDH level，the risk of hypothyroidism occurrence was markedly elevated after radiotherapy and sequential immunotherapy.

Key words: nasopharyngeal carcinoma,  , radiotherapy,  , immunotherapy,  , hypothyroidism, risk factors ,

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