Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Çapa, Istanbul, Turkey.
Thyroid. 2011 Dec;21(12):1301-8. doi: 10.1089/thy.2011.0122.
In papillary thyroid carcinoma (PTC), recurrences during long-term follow-up (R-LTFU) occur even in those who appear to have an excellent prognosis after initial thyroid surgery and usually, radioactive iodine (i.e., "primary treatment"). Initial studies that predict R-LTFU are not well defined. Values for serum thyroglobulin (Tg) measurements when serum thyrotropin (TSH) is >30 μU/mL, as a result of either recombinant TSH or L-thyroxine withdrawal, referred to here as stimulated Tg (STg), have been previously evaluated. The aim of the current study was to determine the parameters associated with R-LTFU in patients with PTC categorized as having low-risk disease 9 to 12 months after their primary treatment.
This was a retrospective study of 469 patients with PTC with a mean follow-up 5.8±3.9 years. Study patients had to have no uptake in the first postablative diagnostic (131)iodine whole body scan (WBS) performed 9-12 months after primary treatment, a normal cervical ultrasonography (C-US), and STg of <2 ng/mL if their test for antithyroglobulin antibody (anti-Tg) was negative. The first two criteria were required for patients with a positive anti-Tg test, and their nominal serum Tg concentrations were not analyzed.
Twelve patients developed recurrences (2.6%) in cervical region. Greater tumor size, higher STg, and positive anti-Tg tests at initial evaluation were associated with greater R-LTFU. The recurrence rates were 1.5% (7/450) and 26% (5/19), respectively, in patients with negative and positive anti-Tg tests at initial evaluation. Recurrence-free survival was lower in the patients with initial lymph node metastases, positive anti-Tg tests, and STg of ≥0.3 ng/mL at the first postablative WBS (p=0.022, 0.001, 0.035, respectively, by log-rank test). Regression analysis in patients who were anti-Tg negative revealed that STg ≥0.3 ng/mL at this first WBS was the only parameter related to recurrence (p=0.031, odds ratio: 10.30, confidence interval: 1.23-83.3).
Patients with PTC traditionally categorized as low risk during their first 9 to 12 months after primary treatment have a greater risk of R-LTFU if their postablative STg is ≥0.3 ng/mL, or they have positive anti-Tg, even at this early stage. Periodic C-US is important in these patients and should probably be more frequent in patients with PTC who have positive anti-Tg tests or STg ≥0.3 ng/mL in the first year after diagnosis.
在甲状腺乳头状癌（PTC）中，即使在初始甲状腺手术后表现出良好预后的患者中，也会在长期随访（R-LTFU）期间出现复发，通常是放射性碘（即“初始治疗”）。目前尚未明确预测 R-LTFU 的初始研究。这里提到的是，当血清促甲状腺激素（TSH）>30μU/mL 时，由于重组 TSH 或 L-甲状腺素停药而导致的血清甲状腺球蛋白（Tg）测量值（称为刺激 Tg [STg]）之前已经进行了评估。本研究的目的是确定在初始治疗后 9-12 个月被归类为低危疾病的 PTC 患者中与 R-LTFU 相关的参数。
这是一项回顾性研究，纳入了 469 例 PTC 患者，平均随访时间为 5.8±3.9 年。研究患者必须在初始治疗后 9-12 个月进行的第一次消融后诊断性（131）碘全身扫描（WBS）中无摄取，颈部超声检查（C-US）正常，并且如果其抗甲状腺球蛋白抗体（抗-Tg）检测为阴性，则 STg<2ng/mL。对于抗-Tg 检测阳性的患者，前两个标准是必需的，并且不分析他们的名义血清 Tg 浓度。
12 例患者在颈部区域出现复发（2.6%）。初始评估时肿瘤较大、STg 较高和抗-Tg 检测阳性与 R-LTFU 较高相关。在初始评估时抗-Tg 检测阴性和阳性的患者中，复发率分别为 1.5%（7/450）和 26%（5/19）。在初始淋巴结转移、抗-Tg 检测阳性和第一次消融后 WBS 时 STg≥0.3ng/mL 的患者中，无复发生存率较低（p=0.022、0.001、0.035，分别通过对数秩检验）。在抗-Tg 阴性的患者中进行回归分析显示，第一次 WBS 时 STg≥0.3ng/mL 是唯一与复发相关的参数（p=0.031，优势比：10.30，置信区间：1.23-83.3）。
在初始治疗后 9-12 个月期间被归类为低危的 PTC 患者，如果其消融后 STg≥0.3ng/mL，或他们具有阳性抗-Tg，即使在早期阶段，也有更大的 R-LTFU 风险。在这些患者中，定期进行 C-US 很重要，并且对于初始诊断后第一年具有阳性抗-Tg 检测或 STg≥0.3ng/mL 的 PTC 患者，可能需要更频繁地进行 C-US。
