分化型甲状腺癌淋巴结复发。淋巴结清扫术后辅助放射性碘治疗的作用。
Differentiated Thyroid Cancer lymph-node relapse. Role of adjuvant radioactive iodine therapy after lymphadenectomy.
作者信息
Piccardo Arnoldo, Puntoni Matteo, Bottoni Gianluca, Treglia Giorgio, Foppiani Luca, Bertoli Mattia, Catrambone Ugo, Arlandini Anselmo, Dib Bassam, Altrinetti Vania, Massollo Michela, Bossert Irene, Cabria Manlio, Bertagna Francesco, Giovanella Luca
机构信息
Department of Nuclear Medicine, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy.
Clinical Trial Unit, Office of the Scientific Director, Galliera Hospital, Genoa, Italy.
出版信息
Eur J Nucl Med Mol Imaging. 2017 Jun;44(6):926-934. doi: 10.1007/s00259-016-3593-0. Epub 2016 Dec 14.
PURPOSE
Our purpose as to evaluate the impact of adjuvant radioactive iodine therapy (RAI) on prognosis, as assessed by progression-free survival (PFS) and overall survival (OS), in patients affected by differentiated thyroid carcinoma (DTC) lymph-node relapse and previously treated with lymphadenectomy.
METHODS
We retrospectively evaluated DTC patients treated with lymph-node dissection for disease relapse. All patients had previously undergone total thyroidectomy and radioiodine remnant ablation (RRA). We used clinical and histological data obtained during follow-up to assess response and outcome. By means of univariate and multivariate time-to-event analyses, we assessed the impact of RAI on outcome (PFS and OS) and the prognostic role of thyroglobulin (Tg) levels under suppression with levothyroxine (Tg-on) measured 1-3 months after lymphadenectomy and of other risk factors.
RESULTS
We evaluated 113 patients (age at diagnosis: median 41 years, interquartile range: 31-59), 64 of whom were treated with RAI. Over a median follow-up time of 5.7 years, 27 patients showed disease progression and 13 died. Kaplan-Meier PFS and OS curves showed that age on diagnosis, tumor histology, tumor size, DTC aggressive variant, and Tg-on were associated with prognosis. Patients with Tg-on ≥1 ng/ml treated with RAI showed a better PFS (Log-rank pp 0.001) and OS (p = 0.005) than untreated patients, while no effect of RAI was observed in patients with Tg-on <1 ng/ml. Multivariate models showed that age, Tg-on (≥1 vs. < 1 ng/ml, HR: 18.2, 95% CI: 5.09-64.8, p = 0.001) and RAI (Yes vs. No, HR: 0.36,95%CI: 0.15-0. 9, p = 0.02) remained the only independent factors associated with PFS, but only age and Tg-on remained significantly associated with OS (HR: 8.31, 95%CI:1.56-44.3, p = 0.01). Nonetheless, patients treated with RAI showed a lower risk of mortality (HR: 0.34, 95%CI: 0.1-1.15 p = 0.08) than untreated patients.
CONCLUSIONS
RAI after lymphadenectomy for DTC relapse is significantly associated with better PFS only in patients with Tg-on ≥1 ng/ml.
目的
我们旨在评估辅助放射性碘治疗（RAI）对分化型甲状腺癌（DTC）淋巴结复发且先前接受过淋巴结清扫术的患者预后的影响，通过无进展生存期（PFS）和总生存期（OS）进行评估。
方法
我们回顾性评估了因疾病复发接受淋巴结清扫术的DTC患者。所有患者先前均接受了甲状腺全切除术和放射性碘残留消融（RRA）。我们使用随访期间获得的临床和组织学数据来评估反应和结局。通过单因素和多因素事件发生时间分析，我们评估了RAI对结局（PFS和OS）的影响以及甲状腺球蛋白（Tg）水平在淋巴结清扫术后1 - 3个月测量的左甲状腺素抑制下（Tg-on）和其他危险因素的预后作用。
结果
我们评估了113例患者（诊断时年龄：中位数41岁，四分位间距：31 - 59岁），其中64例接受了RAI治疗。在中位随访时间5.7年期间，27例患者出现疾病进展，13例死亡。Kaplan-Meier PFS和OS曲线显示，诊断时年龄、肿瘤组织学、肿瘤大小、DTC侵袭性变体和Tg-on与预后相关。Tg-on≥1 ng/ml且接受RAI治疗的患者比未治疗的患者表现出更好的PFS（对数秩检验p = 0.001）和OS（p = 0.005），而在Tg-on <1 ng/ml的患者中未观察到RAI的效果。多因素模型显示，年龄、Tg-on（≥1 vs. <1 ng/ml，HR：18.2，95%CI：5.09 - 64.8，p = 0.001）和RAI（是vs.否，HR：0.36，95%CI：0.15 - 0.9，p = 0.02）仍然是与PFS相关的唯一独立因素，但只有年龄和Tg-on仍然与OS显著相关（HR：8.31，95%CI：1.56 - 44.3，p = 0.01）。尽管如此，接受RAI治疗的患者比未治疗的患者显示出更低的死亡风险（HR：0.34，95%CI：0.1 - 1.15，p = 0.08）。
结论
DTC复发淋巴结清扫术后的RAI仅在Tg-on≥1 ng/ml的患者中与更好的PFS显著相关。
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