Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwongil, Songpa-gu, Seoul 138-736, Korea.
J Clin Endocrinol Metab. 2011 Dec;96(12):3695-700. doi: 10.1210/jc.2011-1270. Epub 2011 Oct 5.
Some patients have elevated stimulated thyroglobulin (sTg) concentrations after reoperation for locoregionally recurrent/persistent papillary thyroid cancer (PTC). Little is known, however, about the efficacy of adjuvant radioactive iodine (RAI) therapy in these patients.
The objective of the study was to evaluate the efficacy of adjuvant RAI therapy in patients with elevated sTg after reoperation for locally recurrent/persistent PTC.
This was a retrospective observational cohort study in a tertiary referral hospital.
We evaluated 45 consecutive patients with sTg greater than 2 ng/ml after reoperation for locoregionally recurrent PTC, all of whom had previously undergone initial total thyroidectomy followed by high-dose RAI remnant ablation. Of these 45 patients, 23 received adjuvant RAI therapy (adjuvant group) and 22 did not (control group).
Main outcome measures included changes in sTg concentration after reoperation and disease-free survival.
Over time, there were no significant differences in mean sTg concentration in the adjuvant (P = 0.35) and control (P = 0.74) groups. Only 15% of patients in the adjuvant group and 33% in the control group showed a greater than 50% decrease in sTg level from baseline. There were no between-group differences in changes (P = 0.83) or percent decrease (P = 0.97) in sTg concentration and no difference in clinical recurrence-free survival (P = 0.20).
In patients who still have elevated sTg after reoperation for locally recurrent/persistent PTC, adjuvant RAI therapy compared with no additional RAI therapy resulted in no significant differences in the subsequent sTg changes or the recurrence-free survival.
一些局部复发性/持续性甲状腺乳头状癌（PTC）患者在再次手术后甲状腺球蛋白刺激值（sTg）升高。然而，人们对这些患者辅助放射性碘（RAI）治疗的疗效知之甚少。
本研究旨在评估局部复发性/持续性 PTC 再次手术后 sTg 升高患者接受辅助 RAI 治疗的疗效。
这是一项在三级转诊医院进行的回顾性观察队列研究。
我们评估了 45 例 sTg 大于 2ng/ml 的局部复发性 PTC 再次手术后患者，所有患者均接受过初始全甲状腺切除术，然后进行高剂量 RAI 残余消融术。在这 45 例患者中，23 例接受了辅助 RAI 治疗（辅助组），22 例未接受（对照组）。
主要观察指标包括再次手术后 sTg 浓度的变化和无病生存率。
随着时间的推移，辅助组（P=0.35）和对照组（P=0.74）的 sTg 浓度平均值无显著差异。辅助组仅 15%的患者和对照组 33%的患者 sTg 水平从基线下降超过 50%。两组间 sTg 浓度变化（P=0.83）或降低百分比（P=0.97）无差异，临床无复发生存率也无差异（P=0.20）。
在局部复发性/持续性 PTC 再次手术后 sTg 仍升高的患者中，与不进行额外 RAI 治疗相比，辅助 RAI 治疗并未导致 sTg 变化或无复发生存率的显著差异。
