Unidade de Doenças da Tireoide, Divisão de Endocrinologia, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil.
Departamento de Saúde Coletiva, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil.
Arch Endocrinol Metab. 2021 Oct 29;65(5):579-587. doi: 10.20945/2359-3997000000341. Epub 2021 Mar 19.
Although thyroid microcarcinoma (TMC) usually has a favorable prognosis, some patients present a higher risk of disease recurrence or persistence. Thus, we aimed at identifying possible risk factors associated with an incomplete response to therapy in TMC.
This was a retrospective study of 517 patients with TMC treated with total thyroidectomy, with or without radioactive iodine (RAI) therapy, reclassified after 1.1 ± 0.4 years according to the response to treatment into "favourable" (excellent/indeterminate) or "unfavorable" (biochemical/structural incomplete) responses. We evaluated participants' age, sex, tumor size, histological variants, multifocality, presence of vascular/lymphatic/perineural invasion, extrathyroidal extension, metastatic lymph nodes (LN), and distant metastasis. The effect of RAI therapy on the response range was analyzed in a given subgroup.
The mean age observed was 46.4 ± 12.0 years, and 89.7% were female. We noted 97.5% with papillary carcinoma, 27.8% with multifocality and 11.2% with LN metastasis. Although the majority of patients had a low risk of recurrence/persistence (78%), 75% were submitted to RAI therapy. Incomplete response (20.7%) was associated with multifocality (p=0.041; OR=1.619) and metastatic LN (p=0.041; OR=1.868). These variables were strongly correlated (p=0.000; OR=3.283). No cut-off of tumor size was identified as a predictor of incomplete response by the receiver operating curve analysis. RAI treatment did not influence the response of patients with multifocality or LN metastasis.
Multifocality and LN metastasis are independent risk factors for incomplete response in TMC patients and are strongly correlated. Additional RAI therapy was not associated with a more favorable response in these subgroups.
尽管甲状腺微小癌（TMC）通常预后良好，但部分患者存在疾病复发或持续存在的较高风险。因此，我们旨在确定与 TMC 治疗不完全反应相关的可能危险因素。
这是一项回顾性研究，共纳入 517 例 TMC 患者，均接受了甲状腺全切除术，部分患者联合放射性碘（RAI）治疗。根据治疗反应，在 1.1±0.4 年后重新分类为“良好”（优秀/不确定）或“不良”（生化/结构不完全）反应。我们评估了患者的年龄、性别、肿瘤大小、组织学变异、多灶性、血管/淋巴管/神经周围侵犯、甲状腺外侵犯、转移性淋巴结（LN）和远处转移的存在情况。分析了 RAI 治疗对特定亚组反应范围的影响。
患者的平均年龄为 46.4±12.0 岁，89.7%为女性。我们观察到 97.5%的患者为乳头状癌，27.8%为多灶性，11.2%为 LN 转移。尽管大多数患者的复发/持续存在风险较低（78%），但仍有 75%的患者接受了 RAI 治疗。不完全反应（20.7%）与多灶性（p=0.041；OR=1.619）和转移性 LN（p=0.041；OR=1.868）相关。这些变量之间存在强烈的相关性（p=0.000；OR=3.283）。ROC 曲线分析未确定肿瘤大小的临界值可预测不完全反应。RAI 治疗并未影响多灶性或 LN 转移患者的反应。
多灶性和 LN 转移是 TMC 患者不完全反应的独立危险因素，且两者之间存在强烈相关性。在这些亚组中，额外的 RAI 治疗并不能带来更有利的反应。
