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目的总结接受舒尼替尼治疗的转移性肾细胞癌患者的甲状腺功能变化规律,评价舒尼替尼对甲状腺功能的影响。方法前瞻性收集北京大学第一医院泌尿外科2008年6月至2010年4月37例转移性肾细胞癌接受舒尼替尼治疗的患者的临床资料,其中22例患者于基线及每个治疗周期第28天进行甲状腺功能检测。对甲状腺功能异常发生情况进行分析。结果 22例患者接受舒尼替尼的中位治疗时间为7个周期(10.5个月),共18例(81.8%)患者出现甲状腺功能减低,其中亚临床甲状腺功能减低14例(63.6%),临床甲状腺功能减低4例(18.2%),予左旋甲状腺素片替代治疗;6例(27.3%)患者出现一过性亚临床甲状腺毒症后转为甲状腺功能减退,无持续甲状腺功能亢进患者。甲状腺功能减低的风险随舒尼替尼用药时间延长而增加,出现甲状腺功能减退的中位时间为3个周期(1～7个周期)。治疗3个周期内,50.0%(11/22例)的患者出现甲状腺功能减退;4～6个周期时,约72.7%(16/22例)患者出现甲状腺功能减退。结论舒尼替尼致甲状腺功能减退的发生率较高,程度可较严重,应引起临床重视。舒尼替尼相关性甲状腺功能减退可以用激素替代进行治疗,因此应避免舒尼替尼减量或停药。
Objective To summarize the changes of thyroid function in patients with metastatic renal cell carcinoma who received sunitinib and evaluate the effect of sunitinib on thyroid function. Methods The clinical data of 37 patients with metastatic renal cell carcinoma receiving sunitinib from June 2008 to April 2010 were collected prospectively from Department of Urology, Peking University First Hospital. Among them, 22 patients were treated at baseline and every treatment cycle Day 28 thyroid function tests. Analysis of the occurrence of thyroid dysfunction. Results The median duration of treatment with sunitinib in 22 patients (10.5 months) was 22 (81.8%). Hypothyroidism was found in 14 patients (63.6%) with subclinical hypothyroidism, Four patients (18.2%) with clinical hypothyroidism were treated with levothyroxine replacement therapy. Six patients (27.3%) had hypothyroidism after transient subclinical thyrotoxicosis without persistent hyperthyroidism. The risk of hypothyroidism increased with sunitinib administration, and the median time to hypothyroidism was 3 cycles (1 to 7 cycles). Hypothyroidism occurred in 50.0% (11/22 cases) of patients during the three cycles of treatment. Hypothyroidism occurred in about 72.7% (16/22 patients) at 4-6 cycles. Conclusion Sunitinib caused a higher incidence of hypothyroidism, the degree may be more serious, should cause clinical attention. Sunitinib-related hypothyroidism can be treated with hormone replacement therapy, sunitinib should therefore be avoided or reduced.