Exposure to ionizing radiation increases the risk of myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN), but such risks are not known in well-differentiated thyroid cancer (WDTC) patients treated with radioactive iodine (RAI). A total of 148 215 WDTC patients were identified from Surveillance, Epidemiology and End Results registries between 1973 and 2014, of whom 54% underwent definitive thyroidectomy and 46% received adjuvant RAI. With a median follow-up of 6.6 years, 77 and 66 WDTC patients developed MDS and MPN, respectively. Excess absolute risks for MDS and MPN from RAI treatment when compared to background rates in the US population were 6.6 and 8.1 cases per 100 000 person-years, respectively. Compared to background population rates, relative risks of developing MDS (3.85 (95% confidence interval, 1.7-7.6); P=0.0005) and MPN (3.13 (1.1-6.8); P=0.012) were significantly elevated in the second and third year following adjuvant RAI therapy, but not after thyroidectomy alone. The increased risk was significantly associated with WDTC size ⩾2 cm or regional disease. Development of MDS was associated with shorter median overall survival in WDTC survivors (10.3 vs 22.5 years; P<0.001). These data suggest that RAI treatment for WDTC is associated with increased risk of MDS with short latency and poor survival.

中文翻译：

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用放射性碘治疗的高分化甲状腺癌患者发生慢性骨髓瘤的风险。

暴露于电离辐射中会增加骨髓增生异常综合症（MDS）和骨髓增生性肿瘤（MPN）的风险，但在接受放射性碘（RAI）治疗的高分化甲状腺癌（WDTC）患者中这种风险未知。在1973年至2014年之间，从监视，流行病学和最终结果登记处总共鉴定出148 215名WDTC患者，其中54％接受了明确的甲状腺切除术，46％接受了辅助性RAI。中位随访6.6年，分别有77和66名WDTC患者发展为MDS和MPN。与美国人群的本底比率相比，来自RAI治疗的MDS和MPN绝对风险分别为每10万人年6.6和8.1例。与背景人群比率相比，发展MDS的相对风险（3.85（95％置信区间为1.7-7.6）； P = 0。0005和MPN（3.13（1.1-6.8）； P = 0.012）在辅助性RAI治疗后的第二年和第三年显着升高，但仅在甲状腺切除术后没有升高。风险增加与WDTC大小小于2 cm或局部疾病显着相关。MDS的发展与WDTC幸存者的中位总体生存期较短有关（10.3 vs 22.5年； P <0.001）。这些数据表明，针对WDTC的RAI治疗与MDS风险增加，潜伏期短和生存期差有关。P ＜0.001）。这些数据表明，针对WDTC的RAI治疗与MDS风险增加，潜伏期短和生存期差有关。P ＜0.001）。这些数据表明，针对WDTC的RAI治疗与MDS风险增加，潜伏期短和生存期差有关。