Shen Feng-Chih, Hsieh Ching-Jung, Huang I-Chin, Chang Yen-Hsiang, Wang Pei-Wen
1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan .
2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Paochien Hospital , PingTung, Taiwan .
Thyroid. 2017 Apr;27(4):531-536. doi: 10.1089/thy.2016.0479. Epub 2017 Jan 23.
This study was conducted to compare the staging systems for the prediction of long-term disease status in patients with well-differentiated thyroid carcinoma (WDTC), and to find out the earliest postoperative period predictor of long-term persistence/recurrence of disease.
Patients with WDTC (n = 356; M = 41.5 ± 12.7 years) followed for at least five years (12.3 ± 5.0 years) after thyroidectomy and I remnant ablation at a tertiary regional hospital in Taiwan were retrospectively studied. Each patient was risk stratified using the American Joint Cancer Committee (stage I-IV) and American Thyroid Association (low, intermediate, and high risk) staging systems after operation and first I remnant ablation and using response to initial therapy reclassification (RTR; excellent, indeterminate, biochemical incomplete, and structural incomplete response) system, which is determined 6-24 months after the first I ablation. The clinical outcome was defined as no evidence of disease (NED; suppressed thyroglobulin [Tg] <0.5 ng/mL, stimulated Tg <1 ng/mL, and no structural detectable disease), biochemical persistent disease (BPD; suppressed Tg ≥0.5 ng/mL or stimulated Tg ≥1 ng/mL in the absence of structural disease), structural persistent disease (SPD; locoregional or distant metastases with any Tg level), or recurrent disease (RD; biochemical or structural disease identified after a period of NED).
At the time of final follow-up, 78.4% (n = 279) of the patients had NED, 9.3% (n = 33) had BPD, 10.1% (n = 36) had SPD, and 2.2% (n = 8) developed RD. All three systems could predict the increasing trend of SPD and the decreasing trend of NED with advancing stage of disease. However, the ATA risk estimates could be significantly refined by the RTR system, especially for the ATA high-risk group, in which 29.2% developed SPD/RD during follow-up. The RTR system reduced the likelihood of finding SPD/RD to 3.7% in those demonstrating an excellent response to therapy, and increased the likelihood to 78.6% in those demonstrating a structural incomplete response. Among the earliest postoperative factors, only the Tg level at the first I ablation could predict long-term persistence/recurrence.
The results highly support incorporating the RTR system to modify the initial risk estimate during follow-up among Chinese patients with WDTC.
本研究旨在比较不同分期系统对高分化甲状腺癌（WDTC）患者长期疾病状态的预测能力，并找出疾病长期持续/复发的最早术后预测指标。
回顾性研究了台湾一家三级区域医院中356例WDTC患者（年龄41.5±12.7岁），这些患者在甲状腺切除和碘残留消融术后至少随访了5年（12.3±5.0年）。术后及首次碘残留消融后，根据美国癌症联合委员会（I-IV期）和美国甲状腺协会（低、中、高风险）分期系统对每位患者进行风险分层，并使用首次碘消融后6-24个月确定的初始治疗反应重新分类（RTR；优、不确定、生化不完全和结构不完全反应）系统。临床结局定义为无疾病证据（NED；抑制状态下甲状腺球蛋白[Tg]<0.5 ng/mL，刺激状态下Tg<1 ng/mL，且无结构可检测疾病）、生化持续性疾病（BPD；抑制状态下Tg≥0.5 ng/mL或刺激状态下Tg≥1 ng/mL且无结构疾病）、结构持续性疾病（SPD；任何Tg水平下的局部或远处转移）或复发性疾病（RD；在一段NED期后发现的生化或结构疾病）。
在最后随访时，78.4%（n = 279）的患者处于NED状态，9.3%（n = 33）有BPD，10.1%（n = 36）有SPD，2.2%（n = 8）发生了RD。所有三种系统都能预测随着疾病分期进展SPD的增加趋势和NED的减少趋势。然而，RTR系统可显著细化ATA风险评估，特别是对于ATA高风险组，该组在随访期间有29.2%发生了SPD/RD。RTR系统将治疗反应优的患者中发现SPD/RD的可能性降低至3.7%，而将结构不完全反应的患者中发现SPD/RD的可能性提高至78.6%。在最早的术后因素中，只有首次碘消融时的Tg水平可预测长期持续/复发。
研究结果有力支持在中国WDTC患者的随访中纳入RTR系统以修正初始风险评估。
