National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
Radiology and Imaging Sciences Department, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland.
Clin Endocrinol (Oxf). 2018 Oct;89(4):481-488. doi: 10.1111/cen.13806. Epub 2018 Aug 13.
Pretreatment with lithium (Li) is associated with an increased residence time of radioactive iodine (RAI) in differentiated thyroid cancer (DTC) metastases. There are no data translating this observation into long-term outcomes. The study goal was to compare the efficacy of three methods of preparation for RAI therapy in metastatic DTC-thyroid hormone withdrawal (THW), THW with pretreatment with Li (THW+Li), and recombinant human TSH (rhTSH).
DESIGN/PATIENTS/MEASUREMENTS: We performed a cohort study comparing overall survival (OS) and progression-free survival (PFS) between the three groups: THW (n = 52), THW+Li (n = 41) and rhTSH (n = 42). Kaplan-Meier analyses were performed to compare OS and PFS between the groups. Cox proportional hazards regression model with a stepwise variable selection was performed to study the contribution of age, gender, histology, TNM status, a location of distant metastases and RAI dose.
During the follow-up of median 5.1 (IQR = 3.0-8.1) years, 52% of patients had disease progression and 12.6% died. Although THW+Li group was characterized by the longest OS (P = 0.007), only age (HR 1.05, CI 1.01-1.09, P = 0.01) and widespread disease (HR 3.8, CI 1.2-11.8, P = 0.02) were found to affect OS in a multivariate model. There was no difference in PFS between the groups (P = 0.47). Presence of distant metastases limited to the lungs only was associated with longer PFS (PFS HR 0.35, CI 0.20-0.60, P = 0.0002).
The older age is associated with shorter OS, while disease burden affects OS and PFS in patients with metastatic thyroid cancer. The method of preparation for RAI therapy does not affect the outcome.
锂（Li）预处理可使分化型甲状腺癌（DTC）转移灶中放射性碘（RAI）的停留时间延长。目前尚无将这一观察结果转化为长期结果的数据。本研究旨在比较三种 RAI 治疗准备方法在转移性 DTC 中的疗效——甲状腺激素剥夺（THW）、THW 加 Li 预处理（THW+Li）和重组人促甲状腺激素（rhTSH）。
设计/患者/测量：我们进行了一项队列研究，比较了三组患者的总生存（OS）和无进展生存（PFS）：THW（n=52）、THW+Li（n=41）和 rhTSH（n=42）。采用 Kaplan-Meier 分析比较各组间 OS 和 PFS。采用逐步变量选择的 Cox 比例风险回归模型研究年龄、性别、组织学、TNM 分期、远处转移部位和 RAI 剂量对 OS 和 PFS 的影响。
在中位随访 5.1 年（IQR=3.0-8.1）期间，52%的患者发生疾病进展，12.6%的患者死亡。尽管 THW+Li 组的 OS 最长（P=0.007），但仅年龄（HR 1.05，CI 1.01-1.09，P=0.01）和广泛疾病（HR 3.8，CI 1.2-11.8，P=0.02）被发现是影响 OS 的多变量模型中的因素。三组患者的 PFS 无差异（P=0.47）。仅有肺部远处转移与较长的 PFS 相关（PFS HR 0.35，CI 0.20-0.60，P=0.0002）。
年龄越大，OS 越短，而疾病负担影响转移性甲状腺癌患者的 OS 和 PFS。RAI 治疗的准备方法不影响结果。
