Moore Maureen D, Postma Emily, Gray Katherine D, Ullmann Timothy M, Hurley James R, Goldsmith Stanley, Sobel Vivian R, Schulman Aaron, Scognamiglio Theresa, Christos Paul J, Hassett Erin, Luick Jessica, Whitehall Dana, Zarnegar Rasa, Fahey Thomas J
Department of Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, 10021, USA.
Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
World J Surg. 2018 Feb;42(2):343-349. doi: 10.1007/s00268-017-4308-9.
In 2006, a multidisciplinary thyroid conference (MDTC) was implemented to better plan management of thyroid cancer patients at our institution. This study assessed the clinical impact of a MDTC on radioactive iodine (RAI) treatment patterns.
A prospective database (2003-2014) collected patient and tumor characteristics, RAI doses, and tumor recurrences. Patients treated with total thyroidectomy for differentiated thyroid carcinoma ≥1 cm were stratified based on American Thyroid Association (ATA) risk classification. RAI regimens were compared before initiation of MDTC (2003-2005, n = 88), after establishment of MDTC (2007-2009, n = 95), and after the release of 2009 ATA guidelines (2011-2014, n = 181). RAI doses were defined as low (≤75 mCi), intermediate (76-150 mCi), and high (>150 mCi).
There was a significant decrease in the number of patients who received high-dose RAI after implementation of MDTC compared to before initiation of MDTC in the intermediate and high-risk patient groups (p = 0.04 and p < 0.01) without an associated increase in tumor recurrence (11 vs. 7%, p = 0.74). On multivariable analysis, presentation of a patient at MDTC was a negative predictor for receiving high-dose RAI (p = 0.002). As might be expected, there was also a significant decrease in use of RAI after the 2009 ATA guidelines were issued compared to after implementation of MDTC (p < 0.01).
In conjunction with implementation of a thyroid malignancy multidisciplinary conference, we observed significantly decreased postoperative dosing of RAI without increased tumor recurrence. The 2009 ATA guidelines were associated with a further decrease in RAI administration. Treatment for patients with thyroid carcinoma is optimized by a multidisciplinary approach.
2006年，我们机构开展了一次多学科甲状腺会议（MDTC），以更好地规划甲状腺癌患者的管理。本研究评估了MDTC对放射性碘（RAI）治疗模式的临床影响。
一个前瞻性数据库（2003 - 2014年）收集了患者和肿瘤特征、RAI剂量以及肿瘤复发情况。对因分化型甲状腺癌≥1 cm接受全甲状腺切除术的患者，根据美国甲状腺协会（ATA）风险分类进行分层。比较了MDTC启动前（2003 - 2005年，n = 88）、MDTC建立后（2007 - 2009年，n = 95）以及2009年ATA指南发布后（2011 - 2014年，n = 181）的RAI治疗方案。RAI剂量分为低剂量（≤75 mCi）、中等剂量（76 - 150 mCi）和高剂量（>150 mCi）。
与MDTC启动前相比，MDTC实施后中高危患者组接受高剂量RAI的患者数量显著减少（p = 0.04和p < 0.01），且肿瘤复发率未相应增加（11%对7%，p = 0.74）。多变量分析显示，患者参加MDTC是接受高剂量RAI的负性预测因素（p = 0.002）。正如预期的那样，2009年ATA指南发布后与MDTC实施后相比，RAI的使用也显著减少（p < 0.01）。
结合甲状腺恶性肿瘤多学科会议的实施，我们观察到术后RAI剂量显著降低，且肿瘤复发率未增加。2009年ATA指南与RAI给药的进一步减少相关。多学科方法优化了甲状腺癌患者的治疗。
