Moon Jae Hoon, Choi June Young, Jeong Woo-Jin, Ahn Soon-Hyun, Lee Won Woo, Kim Kyoung Min, Choi Sung Hee, Lim Soo, Park Young Joo, Yi Ka Hee, Park Do Joon, Jang Hak Chul
Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam-si, Korea.
Department of Surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Korea.
Clin Endocrinol (Oxf). 2016 Sep;85(3):459-65. doi: 10.1111/cen.13029. Epub 2016 Feb 23.
We investigated the value of the stimulated thyroglobulin (Tg) level at the time of recombinant human thyrotropin (rhTSH)-aided remnant ablation for predicting disease status 1 year later in patients with DTC who underwent total thyroidectomy with central neck dissection (CND).
DESIGN, SETTING, AND PARTICIPANT: This was a prospective observational study of 253 consecutive patients with DTC who underwent rhTSH-aided RAI ablation after total thyroidectomy and prophylactic CND. Patients with evidence of initial distant metastasis or positive Tg antibodies were excluded.
We compared rhTSH-stimulated Tg level at RAI ablation according to the disease status at 1 year and evaluated optimal cut-off value of rhTSH-stimulated Tg. Binary logistic regression analysis was performed to investigate the independent predictive factors for disease status 1 year after ablation.
Among study participants, 228 (90·1%) were considered disease free at 1 year after remnant ablation. Patients with persistent or recurrent disease were more likely to be aged ≥45 years, and to have N1b stage, TNM stage III or IV, and higher rhTSH-stimulated Tg level at RAI ablation. The optimal cut-off of rhTSH-stimulated Tg for predicting persistent or recurrent disease was 1·79 ng/ml, with a negative predictive value of 99·5%. A serum rhTSH-stimulated Tg level ≥1·79 at the time of ablation was independently associated with persistent or recurrent disease 1 year later. N1b stage tended to be associated with persistent or recurrent disease.
A low stimulated serum Tg level at rhTSH-aided RAI ablation may be a favourable prognostic marker in the setting of prophylactic CND.
我们研究了重组人促甲状腺素（rhTSH）辅助甲状腺残余组织消融时刺激甲状腺球蛋白（Tg）水平对预测接受全甲状腺切除术加中央区淋巴结清扫术（CND）的分化型甲状腺癌（DTC）患者1年后疾病状态的价值。
设计、地点和参与者：这是一项对253例连续的DTC患者进行的前瞻性观察性研究，这些患者在全甲状腺切除术后和预防性CND后接受了rhTSH辅助放射性碘（RAI）消融。排除有初始远处转移证据或Tg抗体阳性的患者。
我们根据1年时的疾病状态比较了RAI消融时rhTSH刺激的Tg水平，并评估了rhTSH刺激的Tg的最佳临界值。进行二元逻辑回归分析以研究消融后1年疾病状态的独立预测因素。
在研究参与者中，228例（90.1%）在甲状腺残余组织消融后1年被认为无疾病。持续或复发性疾病的患者更可能年龄≥45岁，具有N1b分期、TNM分期III或IV期，并且在RAI消融时rhTSH刺激的Tg水平更高。预测持续或复发性疾病的rhTSH刺激的Tg的最佳临界值为1.79 ng/ml，阴性预测值为99.5%。消融时血清rhTSH刺激的Tg水平≥1.79与1年后持续或复发性疾病独立相关。N1b分期倾向于与持续或复发性疾病相关。
在预防性CND的情况下，rhTSH辅助RAI消融时低刺激血清Tg水平可能是一个良好的预后标志物。
