Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland.
Ann Nucl Med. 2021 Nov;35(11):1214-1222. doi: 10.1007/s12149-021-01663-y. Epub 2021 Aug 7.
In patients with differentiated thyroid carcinoma (DTC), serum thyroglobulin levels measured at the time of remnant ablation after thyroid hormone withdrawal were shown to have prognostic value for disease-free status. We sought to evaluate serial thyroglobulin measurements at the time of recombinant human thyroid-stimulating hormone (rhTSH)-aided iodine 131 (I) adjuvant treatment as prognostic markers of DTC.
Six hundred-fifty patients with DTC given total/near-total thyroidectomy and adjuvant radioiodine post-rhTSH stimulation were evaluated. Thyroglobulin was measured on day 1 (Tg1; at the time of the first rhTSH injection), day 3 (Tg3; 1 day after the second, final rhTSH injection), and day 6 (Tg6; 3 days post-radioiodine administration). Treatment failure was defined as histopathologically confirmed locoregional recurrence, or radiologically-evident distant metastases (signs of disease on computer tomography (CT) or magnetic resonance imaging (MRI), or abnormal foci of radioiodine or [F] fluorodeoxyglucose ([F]FDG) uptake.
In univariate analysis, Tg1 (p < 0.001) and Tg3 (p < 0.001), but not Tg6, were significantly associated with structural recurrence. In multivariate analysis of the overall cohort, only Tg3 was independently associated with structural recurrence. In multivariate analysis of the subgroup (n = 561) with anti-Tg antibodies titers below the institutional cut-off, 115 IU/mL, Tg1 was an independent prognostic marker. Tg1 and Tg3 cutoffs to best predict structural recurrence were established at 0.7 ng/mL and 1.4 ng/mL, respectively.
Tg1 and Tg3, measurements made after rhTSH stimulation but before radioiodine treatment, independently predict a low risk of treatment failure in patients with DTC. Levels measured post-radioiodine application (e.g., Tg6) are highly variable, lack prognostic value, and hence can be omitted.
在甲状腺滤泡状癌（DTC）患者中，甲状腺激素抑制治疗后行甲状腺残留组织消融时的血清甲状腺球蛋白（Tg）水平对疾病无进展状态具有预后价值。我们旨在评估重组人促甲状腺激素（rhTSH）辅助碘 131（I）辅助治疗时 Tg 连续检测作为 DTC 的预后标志物。
对 650 例接受全甲状腺或近全甲状腺切除术及 rhTSH 刺激后放射性碘治疗的 DTC 患者进行评估。Tg 于 rhTSH 首次注射时的第 1 天（Tg1）、第 2 次，即最后一次 rhTSH 注射后的第 1 天（Tg3）及第 6 天（Tg6）进行测量。治疗失败定义为组织学证实的局部复发，或影像学证实的远处转移（计算机断层扫描（CT）或磁共振成像（MRI）可见的远处转移征象，或放射性碘或[F]氟脱氧葡萄糖（[F]FDG）摄取的异常摄取灶。
在单因素分析中，Tg1（p<0.001）和 Tg3（p<0.001），但 Tg6 与结构复发无显著相关性。在全队列的多因素分析中，只有 Tg3 与结构复发独立相关。在抗甲状腺球蛋白抗体滴度低于机构界值（115 IU/mL）的亚组（n=561）的多因素分析中，Tg1 是独立的预后标志物。建立了 Tg1 和 Tg3 预测结构复发的最佳截断值分别为 0.7 ng/mL 和 1.4 ng/mL。
rhTSH 刺激后但在放射性碘治疗前进行的 Tg1 和 Tg3 测量可独立预测 DTC 患者治疗失败的低风险。放射性碘治疗后测量的水平（如 Tg6）变化较大，缺乏预后价值，因此可以省略。
