Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ann Surg Oncol. 2017 Sep;24(9):2596-2602. doi: 10.1245/s10434-017-5910-7. Epub 2017 Jun 9.
Most of the increase in thyroid cancer in recent decades has been due to papillary thyroid microcarcinoma (PTMC). We evaluated the efficacy of radioiodine remnant ablation (RRA) in patients with PTMC.
This historical cohort study included 1932 PTMC patients without lateral cervical lymph node (LN) or distant metastasis who underwent total thyroidectomy (TT) during the median 8.3 years of follow-up. The clinical outcomes of patients with or without RRA were compared using weighted logistic regression models with the inverse probability of treatment weighting (IPTW) method and considering risk factors, including age, sex, primary tumor size, extrathyroidal extension, multifocality, and central cervical LN metastasis.
The median primary tumor size of the RRA group was significantly larger than that of the no-RRA group (0.7 vs. 0.5 cm, P < 0.001). There were significantly more patients with multifocality, extrathyroidal extension, and cervical LN metastasis in the RRA group compared with the no-RRA group. There was no significant difference in recurrence-free survival between the two groups (P = 0.11). Cox proportional-hazard analysis with IPTW by adjusting for clinicopathological risk factors demonstrated no significant difference in recurrence of PTMC according to RRA treatment (hazard ratio [HR] 2.02; 95% confidence interval [CI] 0.65-6.25; P = 0.2).
RRA had no therapeutic effect on the clinical outcomes of patients with PTMC who underwent TT. Surgical treatment without RRA could be applicable for patients with PTMC if there is no evidence of lateral cervical LN metastasis or distant metastasis.
近几十年来，甲状腺癌的发病率上升主要归因于甲状腺微小乳头状癌（PTMC）。我们评估了放射性碘残余消融（RRA）在 PTMC 患者中的疗效。
本历史队列研究纳入了 1932 例无侧颈淋巴结（LN）或远处转移的 PTMC 患者，这些患者在中位 8.3 年的随访期间接受了全甲状腺切除术（TT）。使用加权逻辑回归模型和逆概率治疗加权（IPTW）方法比较了接受或未接受 RRA 的患者的临床结局，并考虑了年龄、性别、原发肿瘤大小、甲状腺外扩展、多灶性和中央颈 LN 转移等危险因素。
RRA 组的中位原发肿瘤大小明显大于无 RRA 组（0.7 与 0.5cm，P<0.001）。RRA 组的多发病灶、甲状腺外扩展和颈 LN 转移患者明显多于无 RRA 组。两组间无复发生存率无显著差异（P=0.11）。通过 IPTW 对临床病理危险因素进行校正的 Cox 比例风险分析显示，RRA 治疗与 PTMC 复发无显著相关性（风险比[HR] 2.02；95%置信区间[CI] 0.65-6.25；P=0.2）。
对于接受 TT 的 PTMC 患者，RRA 对临床结局无治疗作用。如果没有侧颈 LN 转移或远处转移的证据，不进行 RRA 的手术治疗可能适用于 PTMC 患者。
