Liu Jie-Rui, Liu Yan-Qing, Li Hui, Liang Jun, Lin Yan-Song
Department of Oncology,the Affiliated Hospital of Qingdao University,Qingdao,Shandong 266003,China.
Department of Nuclear Medicine,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2020 Apr 28;42(2):222-227. doi: 10.3881/j.issn.1000-503X.11263.
To tailor the subsequent treatment and follow-up strategy,this study dynamically assessed the response to initial therapy in non-distant metastatic differentiated thyroid cancer (DTC) patients with intermediate and high risk. A total of 184 non-distant metastatic DTC patients (intermediate-risk 111 cases and high-risk 73 cases) were retrospectively enrolled in this study. Based on the results of initial response assessment (6-12 months after initial therapy),patients were divided into two groups:excellent response (ER) group (=113) and non-excellent response (non-ER) group (=71). We compared the differences in clinicopathological features between these 2 groups and evaluated the changes of dynamic response to therapy at the initial and final assessments after initial therapy in all patients. Compared with the ER group,the non-ER group showed a larger tumor size (=2771.500,=0.000),higher proportion of extrathyroidal invasion ( =4.070,=0.044),and higher preablative-stimulated thyroglobulin levels (=1367.500,=0.000). ER was achieved in 31% of patients in the initial non-ER group [including indeterminate response (IDR) and biochemical incomplete response (BIR)] at the final follow-up only by thyroid stimulating hormone (TSH) suppression therapy,among which 63.6% were with intermediate risk (especially the patients with IDR) and 36.4% at high risk. In addition,5.2%(6/113) of patients in the initial ER group were reassessed as IDR,BIR,or even structural incomplete response at the end of the follow-up (among which one patient developed into cervical lymph node recurrence,as confirmed by pathology);the TSH level in these patients fluctuated at 0.56-10.35 μIU/ml and was not corrected in time during the follow-up after initial therapy. Some of non-distant metastatic DTC patients with intermediate and high risks who presented initial non-ER may achieve ER only by TSH suppression therapy over time;in contrast,the patients presented initial ER may develop into non-ER without normalized TSH suppression therapy. The dynamic risk assessment system may provide a real-time assessment of recurrence risk and tailor the subsequent treatment and follow-up strategies.
为了制定后续的治疗和随访策略，本研究动态评估了中高危非远处转移性分化型甲状腺癌（DTC）患者对初始治疗的反应。本研究共回顾性纳入了184例非远处转移性DTC患者（中危111例，高危73例）。根据初始反应评估结果（初始治疗后6 - 12个月），将患者分为两组：良好反应（ER）组（n = 113）和非良好反应（non - ER）组（n = 71）。我们比较了这两组患者临床病理特征的差异，并评估了所有患者初始治疗后初始和最终评估时治疗动态反应的变化。与ER组相比，non - ER组肿瘤体积更大（P = 2771.500，P = 0.000），甲状腺外侵犯比例更高（P = 4.070，P = 0.044），消融前刺激甲状腺球蛋白水平更高（P = 1367.500，P = 0.000）。在最终随访时，初始non - ER组中31%的患者（包括不确定反应（IDR）和生化不完全反应（BIR））仅通过促甲状腺激素（TSH）抑制治疗达到了ER，其中63.6%为中危患者（尤其是IDR患者），36.4%为高危患者。此外，初始ER组中5.2%（6/113）的患者在随访结束时被重新评估为IDR、BIR甚至结构不完全反应（其中1例患者经病理证实发生颈部淋巴结复发）；这些患者的TSH水平在0.56 - 10.35 μIU/ml波动，初始治疗后的随访期间未及时纠正。一些初始表现为non - ER的中高危非远处转移性DTC患者可能仅通过TSH抑制治疗随时间推移达到ER；相反，初始表现为ER的患者如果TSH抑制治疗未规范化可能发展为non - ER。动态风险评估系统可提供复发风险的实时评估，并制定后续的治疗和随访策略。
