Chiapponi Costanza, Hartmann Milan J M, Schmidt Matthias, Faust Michael, Schultheis Anne M, Bruns Christiane J, Alakus Hakan
Department of General, Visceral, Cancer and Transplant Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
Cancers (Basel). 2021 Dec 11;13(24):6230. doi: 10.3390/cancers13246230.
Compared to its more common counterpart papillary thyroid cancer (PTC), follicular thyroid cancer (FTC) has a less favorable outcome, due to its higher incidence of distant metastases and advanced stages at diagnosis. Despite radioiodine (RAI) avidity, metastatic FTC often progresses after radioiodine treatment (RAIT). We aimed at evaluating the indications and outcomes of surgery for cervical relapse of radioiodine refractory FTC. Patients receiving RAIT between 2005 and 2015 at the University Hospital of Cologne, Germany, were screened. Patients with FTC were identified. Demographics, clinic-pathologic characteristics, treatment, and outcome of patients diagnosed with RAI refractory FTC, who underwent cervical surgery in the course of disease, were analyzed. FTC accounted for 8.8% of all thyroid carcinomas undergoing RAIT. In 35.2% of FTC patients, disease persisted or recurred despite a cumulative mean RAI activity of 18.7 GBq ± 11.6 (follow-up 83.5 ± 56.7 months). Distant metastases were diagnosed in 75% of these patients, as bone (57.6%), lung (54.6%), and liver metastases (12.1%). Cervical relapse occurred in 63.6% of these patients and was treated in 57.1% with surgery with, and without, external beam radiation therapy (EBRT). Despite surgery and EBRT, in 75% of patients, cervical relapse recurred again. In conclusion, surgery for cervical radioiodine refractory FTC relapse is often performed in metastatic setting. With and without EBRT, cure is rare, although metastases can appear radioiodine avid. Early biological marker and systemic treatments for these patients are still needed.
与更常见的乳头状甲状腺癌（PTC）相比，滤泡状甲状腺癌（FTC）的预后较差，这是因为其远处转移发生率较高且诊断时多处于晚期。尽管转移性FTC对放射性碘（RAI）摄取良好，但放射性碘治疗（RAIT）后病情仍常进展。我们旨在评估放射性碘难治性FTC颈部复发的手术指征及手术效果。对2005年至2015年期间在德国科隆大学医院接受RAIT治疗的患者进行筛查，确定FTC患者。分析了在疾病过程中接受颈部手术的放射性碘难治性FTC患者的人口统计学、临床病理特征、治疗及预后情况。FTC占所有接受RAIT治疗的甲状腺癌的8.8%。在35.2%的FTC患者中，尽管累积平均RAI活度为18.7 GBq±11.6（随访83.5±56.7个月），疾病仍持续或复发。这些患者中有75%被诊断为远处转移，转移部位为骨（57.6%）、肺（54.6%）和肝转移（12.1%）。这些患者中有63.6%发生颈部复发，其中57.1%接受了手术治疗，部分联合或未联合外照射放疗（EBRT）。尽管进行了手术和EBRT，但75%的患者颈部复发再次出现。总之，放射性碘难治性FTC颈部复发的手术通常在有转移的情况下进行。无论是否联合EBRT，治愈都很罕见，尽管转移灶可能表现为对放射性碘摄取良好。这些患者仍需要早期生物标志物及全身治疗。
