Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2021 Jul;96(7):1727-1745. doi: 10.1016/j.mayocp.2021.02.009. Epub 2021 Mar 17.
To determine whether radioiodine remnant ablation (RRA) reduces cause-specific mortality (CSM) or tumor recurrence (TR) rate after bilateral lobar resection (BLR).
There were 2952 low-risk adult papillary thyroid cancer (LRAPTC) patients (with MACIS scores <6) who underwent potentially curative BLR during 1955-2014. During 1955-1974, 1975-1994, and 1995-2014, RRA was administered in 3%, 49%, and 28%. Statistical analyses were performed using SAS software.
During 1955-1974, the 20-year CSM and TR rates after BLR alone were 1.0% and 6.8%; rates after BLR+RRA were 0% (P=.63) and 5.9% (P=.82). During 1975-1994, post-BLR 20-year rates for CSM and TR were 0.3% and 7.5%; after BLR+RRA, rates were higher at 0.9% (P=.31) and 12.8% (P=.01). When TR rates were examined separately for 448 node-negative and 317 node-positive patients, differences were nonsignificant. In 1995-2014, post-BLR 20-year CSM and TR rates were 0% and 9.2%; rates after BLR+RRA were higher at 1.4% (P=.19) and 21.0% (P<.001). In 890 pN0 cases, 15-year locoregional recurrence rates were 3.4% after BLR and 3.7% after BLR+RRA (P=.99). In 740 pN1 patients, 15-year locoregional recurrence rates were 10% higher after BLR+RRA compared with BLR alone (P=.01). However, this difference became nonsignificant when stratified by numbers of metastatic nodes.
RRA administered to LRAPTC patients during 1955-2014 did not reduce either the CSM or TR rate. We would therefore not recommend RRA in LRAPTC patients undergoing BLR with curative intent.
确定放射性碘残留消融（RRA）是否降低双侧叶切除（BLR）后特定原因死亡率（CSM）或肿瘤复发（TR）率。
共有 2952 例低危成人甲状腺乳头状癌（LRAPTC）患者（MACIS 评分<6），于 1955-2014 年期间接受潜在治愈性 BLR。1955-1974 年、1975-1994 年和 1995-2014 年期间，分别有 3%、49%和 28%的患者接受了 RRA。使用 SAS 软件进行统计学分析。
1955-1974 年，BLR 后单独治疗 20 年的 CSM 和 TR 率分别为 1.0%和 6.8%；BLR+RRA 后的比率分别为 0%（P=.63）和 5.9%（P=.82）。1975-1994 年，BLR 后 20 年的 CSM 和 TR 发生率分别为 0.3%和 7.5%；BLR+RRA 后的发生率分别为 0.9%（P=.31）和 12.8%（P=.01）。对 448 例无淋巴结转移和 317 例淋巴结转移患者的 TR 发生率分别进行检查，差异无统计学意义。1995-2014 年，BLR 后 20 年的 CSM 和 TR 发生率分别为 0%和 9.2%；BLR+RRA 后的发生率分别为 1.4%（P=.19）和 21.0%（P<.001）。在 890 例 pN0 病例中，BLR 后的 15 年局部区域复发率为 3.4%，BLR+RRA 后的复发率为 3.7%（P=.99）。在 740 例 pN1 患者中，与单独 BLR 相比，BLR+RRA 后的 15 年局部区域复发率高 10%（P=.01）。然而，当按转移淋巴结数量分层时，这一差异变得无统计学意义。
1955-2014 年期间，LRAPTC 患者接受 RRA 治疗并未降低 CSM 或 TR 率。因此，我们不建议对有治愈意图的行 BLR 的 LRAPTC 患者进行 RRA。
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