峡部形态是分化型甲状腺癌患者疾病持续存在的危险因素。

Isthmus topography is a risk factor for persistent disease in patients with differentiated thyroid cancer.

机构信息

Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy.

Thyroid Committee, European Association of Nuclear Medicine, Vienna, Austria.

出版信息

Eur J Endocrinol. 2021 Aug 3;185(3):397-404. doi: 10.1530/EJE-21-0328.

DOI:10.1530/EJE-21-0328

PMID:34232125

Abstract

AIM

The risk of differentiated thyroid cancer (DTC) recurrence is widely evaluated according to the 2015 ATA Risk Stratification System. Topography of malignant nodules has been previously reported as an additional risk factor but is not included in the ATA system. Thus, our study aimed to evaluate the relationship between DTC topography and response to initial therapy.

PATIENTS AND METHODS

We enrolled 401 low- to intermediate-risk patients with DTC who had undergone thyroidectomy and radioiodine therapy. DTC topography was recorded and compared with the response to therapy as assessed 12 months after the end of therapy.

RESULTS

Overall, 366/401 (91.3%) patients had an excellent response to initial therapy while 22/401 (5.5%) and 13/401 (3.2%) had incomplete biochemical or structural responses, respectively. Incomplete response occurred in 10/36 (27.8%), 5/125 (4.0%), and 4/111 (3.6%) patients whose unifocal malignant nodules were located in the isthmus, right lobe, or left lobe. Incomplete response was also observed in 4/54 (7.4%) and 12/75 (16%) patients carrying multifocal cancers in one or both lobes, respectively. Patients with isthmic cancer more frequently demonstrated incomplete response compared with those who had cancer in other locations (P = 0.00). No significant relationship was found with age, gender, maximum size of malignant nodule, Hashimoto's thyroiditis, vascular invasion, and extrathyroidal extension (P = 0.78, P = 0.77, P = 0.52, P = 0.19, P = 0.73, and P = 0.26, respectively). The risk of incomplete response was about 65% higher in patients with isthmic lesions compared with other patients (odds ratio = 6.725). A log-rank test demonstrated that disease-free survival (DFS) of patients with isthmic lesions was significantly shorter than that of other patients (P = 0.02).

CONCLUSION

Our data show that isthmus topography of malignant thyroid nodules is a risk factor for having both persistent disease 12 months after primary treatment and reduced DFS.

摘要

目的

分化型甲状腺癌（DTC）的复发风险根据 2015 年美国甲状腺协会（ATA）风险分层系统进行广泛评估。先前已有报道称恶性结节的位置是另一个危险因素，但并未纳入 ATA 系统。因此，本研究旨在评估 DTC 位置与初始治疗反应之间的关系。

患者和方法

我们纳入了 401 例低-中危 DTC 患者，均接受了甲状腺切除术和放射性碘治疗。记录 DTC 的位置，并与治疗结束后 12 个月的治疗反应进行比较。

结果

总体而言，366/401（91.3%）例患者对初始治疗有极好的反应，而 22/401（5.5%）和 13/401（3.2%）例患者分别出现不完全生化或结构反应。10/36（27.8%）、5/125（4.0%）和 4/111（3.6%）例单灶恶性结节位于峡部、右叶或左叶的患者出现不完全反应，54（7.4%）和 75（16%）例分别有 1 个或 2 个以上病灶的多灶性癌症患者也出现不完全反应。与其他位置的癌症相比，发生于峡部的癌症患者更常出现不完全反应（P = 0.00）。年龄、性别、恶性结节最大直径、桥本甲状腺炎、血管侵犯和甲状腺外侵犯与不完全反应之间无显著相关性（P = 0.78、P = 0.77、P = 0.52、P = 0.19、P = 0.73 和 P = 0.26）。与其他患者相比，峡部病变患者的不完全反应风险约高 65%（优势比=6.725）。对数秩检验显示，峡部病变患者的无疾病生存率（DFS）明显短于其他患者（P = 0.02）。