From the *Endocrinology Service, Universidade Federal do Rio de Janeiro, Rio de Janeiro; and †Endocrinology Service, Instituto Nacional do Câncer, Rio de Janeiro, Brazil.
Clin Nucl Med. 2013 Oct;38(10):765-9. doi: 10.1097/RLU.0b013e31829f8c71.
The evaluation of patients with differentiated thyroid cancer is commonly based on serum thyroglobulin (Tg) measurement and 131I whole-body scan (WBS). The first follow-up (6-12 months after initial treatment) shows the response to therapy, a prognostic factor.The aims of the study were to describe the clinical outcome during a long-term follow-up of patients with negative 131I WBS in the first evaluation, and to assess clinical and histological characteristics related to the outcome in this patient population.
This retrospective study reviewed data from 209 patients followed at 2 Brazilian hospitals. A minimum of 10 years of follow-up was required.
During mean follow-up of 13.7 ± 4.2 years, 20% of patients developed recurrence. At the end of follow-up, 21% of patients had persistent disease. The clinical and histological characteristics related to adverse outcomes (recurrence or persistent disease) were lymph node metastases at diagnosis, high risk according to American Thyroid Association (ATA) classification, and incomplete response to treatment. Stimulated Tg levels (under thyroid hormone withdrawal) and basal Tg levels (with thyroid hormone) greater than 10 ng/mL at first evaluation were associated with an adverse outcome.
Negative WBS at first evaluation should not be used as an isolated prognostic factor. This must be considered together with histopathological (ATA classification, lymph node metastases) and clinical/laboratory characteristics (stimulated and basal Tg; response to therapy).
分化型甲状腺癌患者的评估通常基于血清甲状腺球蛋白（Tg）测量和 131I 全身扫描（WBS）。首次随访（初始治疗后 6-12 个月）显示了对治疗的反应，这是一个预后因素。本研究的目的是描述首次评估中 131I WBS 阴性患者的长期随访期间的临床结果，并评估与该患者人群结局相关的临床和组织学特征。
这项回顾性研究回顾了在巴西的 2 家医院接受随访的 209 名患者的数据。需要至少 10 年的随访。
在平均 13.7 ± 4.2 年的随访期间，20%的患者出现复发。随访结束时，21%的患者仍有疾病。与不良结局（复发或持续性疾病）相关的临床和组织学特征是诊断时的淋巴结转移、根据美国甲状腺协会（ATA）分类的高危，以及治疗反应不完全。首次评估时（在甲状腺激素停药时）刺激 Tg 水平（高于 10ng/mL）和基础 Tg 水平（在甲状腺激素时）大于 10ng/mL 与不良结局相关。
首次评估时的 WBS 阴性不应单独用作预后因素。这必须与组织病理学（ATA 分类、淋巴结转移）和临床/实验室特征（刺激和基础 Tg；治疗反应）一起考虑。
