Pitoia Fabián, Abelleira Erika, Tala Hernán, Bueno Fernanda, Urciuoli Carolina, Cross Graciela
Endocrine. 2014 Aug;46(3):532-7. doi: 10.1007/s12020-013-0097-6. Epub 2013 Nov 28.
To evaluate the outcome of differentiated thyroid cancer (DTC) patients with biochemical persistence of disease (BP) after initial treatment (total thyroidectomy with or without lymph node dissection (LND) and thyroid remnant ablation). BP was defined as suppressed thyroglobulin (Tg) levels <1 ng/ml and rhTSH-stimulated thyroglobulin (St-Tg) >1ng/ml, with no evidence of structural disease. Structural persistence/recurrence (SPR): clinically identifiable disease. We reviewed 278 records of DTC patients. Tg-Ab positive patients (n = 73) were excluded and 32 were included in the analysis (median age 45 years, range 18-77 years); risk of recurrence ATA was: low in 38 %, Intermediate in 47 %, and high in 15 % of patients. All subjects had Tg levels <1 ng/ml under thyroid hormone therapy. Patients were divided into three groups: Group 1: St-Tg 1-2 ng/ml, n = 6; Group 2: St-Tg 2-10 ng/ml, n = 17; Group 3: St-Tg > 10 ng/ml, n = 9. In 5/32 (16 %) patients, SPR was observed after a median follow-up of 6 years (range 2-23 years). In Group 1: all patients were considered with no evidence of disease after a median follow-up of 2 years (range 1-2.5 years). In Group 2: 13/17 (76.5 %) patients continued with only a BP after a median follow-up of 4 years (range 2-10 years) and 4/17 (23.5 %) patients with intermediate risk of recurrence had a structural persistence (lymph nodes metastasis) diagnosed between 1 and 3.5 years after initial assessment. Following LND, all of them remained with BP after a median of 2 years (range 1.5-5 years). In Group 3: 8/9 (89 %) patients had BP after a median follow-up of 7 years (range 2-23 years) and 1/9 (11 %) had a SPR diagnosed 28 months after initial assessment, LND was indicated but he continued with BP, 5 years after the second surgery. Most patients with DTC and BP present an indolent course of the disease. In these patients the diagnosis of the structural recurrence did not change the outcome because all of them continued with BP.
为评估分化型甲状腺癌（DTC）患者在初始治疗（全甲状腺切除术伴或不伴淋巴结清扫术（LND）及甲状腺残余消融）后出现生化疾病持续状态（BP）的结局。BP定义为促甲状腺素抑制状态下甲状腺球蛋白（Tg）水平<1 ng/ml且重组人促甲状腺素（rhTSH）刺激后的甲状腺球蛋白（St-Tg）>1 ng/ml，且无结构疾病证据。结构持续/复发（SPR）：临床可识别的疾病。我们回顾了278例DTC患者的记录。Tg抗体阳性患者（n = 73）被排除，32例纳入分析（中位年龄45岁，范围18 - 77岁）；根据美国甲状腺协会（ATA）复发风险分类：低风险患者占38%，中风险患者占47%，高风险患者占15%。所有受试者在甲状腺激素治疗下Tg水平<1 ng/ml。患者分为三组：第1组：St-Tg 1 - 2 ng/ml，n = 6；第2组：St-Tg 2 - 10 ng/ml，n = 17；第3组：St-Tg > 10 ng/ml，n = 9。在32例患者中的5例（16%）中，中位随访6年（范围2 - 23年）后观察到SPR。在第1组中：中位随访2年（范围1 - 2.5年）后，所有患者均被认为无疾病证据。在第2组中：中位随访4年（范围2 - 10年）后，17例患者中的13例（76.5%）仅持续存在BP，17例中复发风险为中等的4例（23.5%）患者在初次评估后1至3.5年被诊断为结构持续（淋巴结转移）。LND后，中位2年（范围1.5 - 5年）后他们均仍处于BP状态。在第3组中：中位随访7年（范围2 - 23年）后，9例患者中的8例（89%）处于BP状态，9例中的1例（11%）在初次评估后28个月被诊断为SPR，虽建议行LND但他在第二次手术后5年仍处于BP状态。大多数患有DTC和BP的患者疾病进程较为惰性。在这些患者中，结构复发的诊断并未改变结局，因为他们均持续处于BP状态。
