Bal Chandrasekhar, Ballal Sanjana, Soundararajan Ramya, Chopra Saurav, Garg Aayushi
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
Medical Student, All India institute of Medical Sciences, New Delhi, 110029, India.
Cancer Med. 2015 Jul;4(7):1031-8. doi: 10.1002/cam4.443. Epub 2015 Mar 9.
Low-risk (LR) differentiated thyroid cancer (DTC) patients should be ablated or not, albeit, with small dose of radioiodine is highly controversial. We hypothesized that those LR DTC patients who were surgically ablated need no radioiodine remnant ablation (RRA). This study aims to evaluate the long-term outcome in these two groups of patients. Retrospective cohort study conducted from January 1991 to December 2012. Based on extent of surgical resection and histopathology, LR DTC patients were classified as Gr-1: 169 patients, who were surgically ablated; Gr-2: 153 patients, who had significant remnant in thyroid bed. Basal parameters were comparable between two groups except pretherapy 24 h radioiodine uptake (0.16 ± 0.01% vs. 5.64 ± 0.46%; P < 0.001). No patient received RRA in Gr-1; Gr-2 patients were administered 30 mCi (131) I. Total number of events (recurrence, persistent, and progression of disease), with median follow up of 10.3 years, was observed in 10/322 (3.1%) of LR DTC patients. Only one patient had disease recurrence from Gr-1, who became disease-free after radioiodine therapy. Similarly, one patient from 126, who was ablated with single dose of RRA, had recurrence from Gr-2. However, 8/27 (29.7%) patients from Gr-2 had persistent disease; even two of them subsequently developed disease progression, who failed first-dose of RRA. The event-free survival rates were 99.4% and 94.1% (P = 0.006) in Gr-1 and Gr-2, respectively. RRA is an overtreatment in surgically ablated LR DTC patients. Successfully ablated RRA patients also had similar long-term outcome, however, those who failed, should be re-stratified as intermediate-risk category, and managed aggressively.
低风险（LR）分化型甲状腺癌（DTC）患者是否应进行消融治疗，即便使用小剂量放射性碘，也极具争议。我们推测，那些接受手术消融的LR DTC患者无需进行放射性碘残留消融（RRA）。本研究旨在评估这两组患者的长期预后。对1991年1月至2012年12月进行回顾性队列研究。根据手术切除范围和组织病理学，LR DTC患者分为两组：1组（Gr-1）：169例接受手术消融的患者；2组（Gr-2）：153例甲状腺床有明显残留的患者。除治疗前24小时放射性碘摄取量外，两组的基础参数具有可比性（0.16±0.01%对5.64±0.46%；P<0.001）。1组中无患者接受RRA；2组患者给予30mCi的（131）I。在中位随访10.3年的LR DTC患者中，共观察到10/322例（3.1%）出现事件（疾病复发、持续存在和进展）。1组中只有1例患者疾病复发，经放射性碘治疗后疾病缓解。同样，2组中126例接受单次RRA消融的患者中有1例复发。然而，2组中有8/27例（29.7%）患者疾病持续存在；其中甚至有2例随后疾病进展，首次RRA治疗失败。1组和2组的无事件生存率分别为99.4%和94.1%（P=0.006）。对于接受手术消融的LR DTC患者，RRA属于过度治疗。成功进行RRA消融的患者也有相似的长期预后，然而，那些治疗失败的患者，应重新分类为中风险类别，并积极治疗。
