Endocrinology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Thyroid. 2012 Oct;22(10):1007-15. doi: 10.1089/thy.2012.0183. Epub 2012 Aug 8.
Multiple studies have demonstrated successful radioactive iodine remnant ablation (RRA) following preparation with recombinant human thyroid stimulating hormone (rhTSH). Short-term studies in relatively low-risk patients have also suggested that rhTSH-stimulated RRA can have an effective adjuvant therapy function in destroying residual microscopic thyroid cancer cells. However, very few of these studies have included a significant number of intermediate or high-risk patients. The goal of this study was to examine clinical outcomes after rhTSH stimulated RRA in a larger cohort of thyroid cancer patients at higher risk of recurrence and disease-specific mortality.
A retrospective chart review identified 586 thyroid cancer patients prepared for RRA with either a thyroid hormone withdrawal (THW) (n=321) or rhTSH preparation (n=265). The primary end points included both the best response to initial therapy and the clinical status at final follow-up. Clinical outcomes were compared within each of the American Thyroid Association (ATA) risk groups (low, intermediate, and high) and American Joint Committee on Cancer (AJCC) stages (I-IV) based on the method of preparation for RRA (THW vs. rhTSH).
Preparation with rhTSH was more likely to be associated with an excellent response to therapy (39.4% for rhTSH vs. 30% for TWH, p=0.03) and fewer additional therapies (29% for rhTSH vs. 37% for TWH, p=0.05) than THW. However, after a median follow-up period of 9 years, the final clinical outcomes were not significantly different with respect to recurrence rates (1.5% for rhTSH vs. 1.2% for TWH), likelihood of having persistent disease (46% for rhTSH vs. 48% for THW) or likelihood of having no evidence of disease (53% for rhTSH vs. 52% for TWH). Furthermore, clinical outcomes were similar between rhTSH and THW preparation across all ATA risk groups and AJCC stages.
rhTSH preparation for RRA is associated with a small, but statistically significant improvement in an initial response to therapy and similar final clinical outcomes across a wide range of risk of recurrence and risk of disease-specific mortality. These data suggest that rhTSH preparation for RRA can be effectively used in intermediate and high-risk patients without known distant metastases.
多项研究表明，重组人促甲状腺激素（rhTSH）准备后放射性碘残余消融（RRA）是成功的。在风险相对较低的患者中进行的短期研究还表明，rhTSH 刺激的 RRA 可以在破坏残留的甲状腺微小癌细胞方面发挥有效的辅助治疗作用。然而，这些研究中很少有包括大量中高危患者的研究。本研究的目的是在复发和疾病特异性死亡率风险较高的更大甲状腺癌患者队列中检查 rhTSH 刺激 RRA 后的临床结果。
回顾性图表审查确定了 586 名准备接受 RRA 的甲状腺癌患者，其中 321 名接受甲状腺激素停药（THW）治疗，265 名接受 rhTSH 治疗。主要终点包括初始治疗的最佳反应和最终随访时的临床状况。根据 RRA 准备方法（THW 与 rhTSH），比较了每个美国甲状腺协会（ATA）风险组（低、中、高）和美国癌症联合委员会（AJCC）分期（I-IV）内的临床结果。
rhTSH 治疗的准备更有可能与治疗的极好反应相关（rhTSH 为 39.4%，THW 为 30%，p=0.03），并且需要的额外治疗更少（rhTSH 为 29%，THW 为 37%，p=0.05）。然而，中位随访 9 年后，复发率（rhTSH 为 1.5%，THW 为 1.2%）、持续性疾病的可能性（rhTSH 为 46%，THW 为 48%）或无疾病证据的可能性（rhTSH 为 53%，THW 为 52%）并无显著差异。此外，rhTSH 和 THW 准备在所有 ATA 风险组和 AJCC 分期之间的临床结果相似。
rhTSH 准备 RRA 与治疗初始反应略有改善相关，与广泛的复发风险和疾病特异性死亡率风险相关的最终临床结果相似。这些数据表明，rhTSH 准备 RRA 可有效用于无远处转移的中高危患者。
