Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China.
Department of Nuclear Medicine, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China.
Clin Endocrinol (Oxf). 2018 Apr;88(4):601-606. doi: 10.1111/cen.13551. Epub 2018 Feb 18.
Whether the initiating time of radioiodine (RAI) therapy will affect the clinical outcome in differentiated thyroid cancer (DTC) remains controversial. The objective of this study was to evaluate the impact of RAI therapy initiating time on response to initial therapy in low- to intermediate-risk DTC.
A total of 235 consecutive patients with low- to intermediate-risk DTC were retrospectively reviewed. According to the time interval between thyroidectomy and RAI therapy, patients were divided into Group 1 (interval < 3 months, n = 187) and Group 2 (interval ≥ 3 months, n = 48). Response to RAI therapy was evaluated as excellent, indeterminate, biochemical incomplete or structural incomplete response (ER, IDR, BIR or SIR) with a median follow-up of 780 days. The univariate and multivariate analyses were further conducted to identify factors associated with incomplete response (IR, including BIR and SIR).
Response to initial therapy was significantly different between 2 groups (P < .05), after excluding the impact of other risk factors (age, gender, histological type, status of T and N, RAI dose, thyrotropin, stimulated thyroglobulin and follow-up time). A significantly higher IR rate (18.8% vs 4.3%, P = .001) and a lower ER proportion (62.5% vs 78.1%, P = .027) were observed in Group 2. By univariate analysis, both T status and N status, stimulated thyroglobulin and time interval were significant risk factors for IR (P < .05). Multivariate analysis demonstrated that the time interval was an independent risk factor for IR (P = .008).
Delayed initial RAI therapy (≥3 months after thyroidectomy) related to incomplete response in low- to intermediate-risk DTC.
放射性碘（RAI）治疗的起始时间是否会影响分化型甲状腺癌（DTC）的临床结局仍存在争议。本研究旨在评估低-中危 DTC 患者 RAI 治疗起始时间对初始治疗反应的影响。
回顾性分析 235 例低-中危 DTC 连续患者。根据甲状腺切除术后至 RAI 治疗的时间间隔，将患者分为第 1 组（间隔<3 个月，n=187）和第 2 组（间隔≥3 个月，n=48）。用中位数为 780 天的随访评估 RAI 治疗的反应为完全缓解、不确定、生化不完全或结构不完全缓解（ER、IDR、BIR 或 SIR）。进一步进行单因素和多因素分析，以确定与不完全缓解（IR，包括 BIR 和 SIR）相关的因素。
两组之间初始治疗的反应有显著差异（P<.05），在排除其他危险因素（年龄、性别、组织学类型、T 和 N 状态、RAI 剂量、促甲状腺激素、刺激甲状腺球蛋白和随访时间）后。第 2 组的 IR 发生率（18.8%比 4.3%，P=.001）和 ER 比例（62.5%比 78.1%，P=.027）均显著升高。单因素分析显示，T 状态、N 状态、刺激甲状腺球蛋白和时间间隔均为 IR 的显著危险因素（P<.05）。多因素分析表明，时间间隔是 IR 的独立危险因素（P=.008）。
甲状腺切除术后 3 个月以上开始初始 RAI 治疗与低-中危 DTC 的不完全缓解相关。
