Service de médecine nucléaire, CLCC Jean Perrin, Clermont-Ferrand, France.
UMR INSERM 1240 "Molecular Imaging and Theranostic Strategy", Clermont Auvergne University, Clermont-Ferrand, France.
PLoS One. 2019 Aug 19;14(8):e0221298. doi: 10.1371/journal.pone.0221298. eCollection 2019.
Differentiated thyroid cancer (DTC) is the most common of endocrine cancers. Many studies have focused on recurrence-free survival of DTC patients, however, few studies have addressed overall survival rates. Given its very good prognosis, estimating overall or long-term survival in patients with DTC seems rational. So far, neither the impact of pre- and post-ablation thyroglobulin, nor that of initial American Thyroid Association (ATA) risk stratification on long-term disease-specific survival, have been sufficiently studied.
The aim of this study was to determine the factors that influence long-term disease-specific survival and thyroglobulin levels in patients with DTC who have been previously treated with thyroidectomy and radioactive iodine (RAI) remnant ablation.
This observational retrospective study included 1093 patients who were treated for DTC between 1995 and 2010 and are still monitored in our tertiary center. Only patients who needed RAI ablation after thyroidectomy were included in this study. Patients who were treated with RAI following rhTSH stimulation, patients who presented positive anti-thyroglobulin antibodies, and patients who had micro-cancers were excluded. Pre-ablation stimulated thyroglobulin (Pre-ablation sTg) was measured after thyroid hormone withdrawal (THW), just before RAI.
According to ATA standards, 29 patients (2.7%) were classified as high-risk patients. Initial ATA high-recurrence risk rating (HR 21.9; 95% CI: 8.5-56.3), age>55 years (HR 23.8; 95%-CI: 7.5-75.3) and pre-ablation sTg≥30 μg/l (HR 8.4; 95% CI: 4.6-15.3) significantly impacted ten-year survival. Moreover, age over 45 years, ATA moderate-risk and follicular DTC were also significant. Ten-year survival was lower in ATA high-risk patients (51% vs 95% and 93% for the low and intermediate risk; p<10-7), patients older than 55 years (82% vs 98%; p<10-7), and in patients with pre-ablation sTg≥30 (78% vs 95%; p<10-7). Three rates of long-term survival were distinguished: excellent (survival rate of 99% in patients<55 years with pre-ablation sTg <30μg/l) representing 59% of the cohort, moderate (survival rate of 94.5% in patients <55 years with pre-ablation sTg ≥30μg/l or ≥55 years with pre-ablation sTg <30 μg/l) representing 38% of the cohort, and low (survival rate of 49% in patients ≥55 years with pre-ablation sTg ≥30μg/l) representing 3% of the cohort.
Initial ATA high-risk classification, age over 55 years old and pre-ablation sTg ≥30 μg/l are the main negative factors that influence the ten-year survival in DTC. We suggest three categories of overall survival rates. Patients older than 55 years with pre-ablation sTg ≥30 μg/l have the worst survival rate.
分化型甲状腺癌（DTC）是最常见的内分泌癌。许多研究都集中在 DTC 患者的无复发生存率上，但很少有研究涉及总生存率。鉴于其良好的预后，估计 DTC 患者的总体或长期生存率似乎是合理的。到目前为止，无论是在甲状腺球蛋白（Tg）清除后，还是在初始美国甲状腺协会（ATA）风险分层后，都没有充分研究 Tg 水平对长期疾病特异性生存的影响。
本研究旨在确定在先前接受甲状腺切除术和放射性碘（RAI）残余消融治疗的 DTC 患者中，影响长期疾病特异性生存和 Tg 水平的因素。
这是一项观察性回顾性研究，纳入了 1995 年至 2010 年间在我们的三级中心接受 DTC 治疗的 1093 例患者。仅纳入了在甲状腺切除术后需要 RAI 消融的患者。接受 rhTSH 刺激后行 RAI 治疗的患者、抗甲状腺球蛋白抗体阳性的患者和微癌患者被排除在外。在 RAI 前，在甲状腺激素停药（THW）后测量预消融刺激 Tg（Pre-ablation sTg）。
根据 ATA 标准，29 例（2.7%）患者被归类为高危患者。初始 ATA 高复发风险评分（HR 21.9；95%CI：8.5-56.3）、年龄>55 岁（HR 23.8；95%-CI：7.5-75.3）和预消融 sTg≥30μg/l（HR 8.4；95%CI：4.6-15.3）显著影响 10 年生存率。此外，年龄>45 岁、ATA 中危和滤泡型 DTC 也有显著影响。ATA 高危患者 10 年生存率较低（51% vs 95%和 93%为低危和中危；p<10-7），年龄>55 岁患者（82% vs 98%；p<10-7），以及预消融 sTg≥30μg/l 患者（78% vs 95%；p<10-7）。区分了三种长期生存情况：极好（<55 岁且预消融 sTg<30μg/l 的患者生存率为 99%）占队列的 59%，中等（<55 岁且预消融 sTg≥30μg/l 或≥55 岁且预消融 sTg<30μg/l 的患者生存率为 94.5%）占队列的 38%，较差（≥55 岁且预消融 sTg≥30μg/l 的患者生存率为 49%）占队列的 3%。
初始 ATA 高危分类、年龄>55 岁和预消融 sTg≥30μg/l 是影响 DTC 患者 10 年生存率的主要负面因素。我们建议将总体生存率分为三类。年龄>55 岁且预消融 sTg≥30μg/l 的患者生存率最差。
