Jia Xi, Wang Yuanbo, Yang Lulu, Fan Kun, Tao Runyi, Liu Hui, Yao Xiaobao, Yang Aimin, Zhang Guangjian, Gao Rui
Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
Diagnostics (Basel). 2022 May 18;12(5):1254. doi: 10.3390/diagnostics12051254.
The intermediate-risk category of papillary thyroid cancer (PTC) comprises heterogeneous patients within a wide range of stages and varied care management. Understanding the risk features of recurrence observed after the initial therapy should be emphasized. We aimed to evaluate the prognostic significance of radioactive iodine-avid lymph nodes observed during the initial treatment of patients with PTC that were considered to be at intermediate risk. Data on patients with intermediate-risk PTC treated from 2012 to 2018 were retrospectively reviewed. Post-therapeutic SPECT/CT (Rx SPECT/CT) was evaluated in the enrolled patients. The clinical, pathologic, and incidence of radioiodine-avid (RAI-avid) lymph node metastasis (mLN) on Rx SPECT/CT were reviewed, and risk factors related to recurrent disease were analyzed. After a median follow-up of 37.26 (30.90, 46.33) months, structural persistent/recurrent disease was detected in 9.81% (36/367) of patients with intermediate-risk tumors. The incidence of recurrence was higher in patients who demonstrated RAI-avid mLN after the initial therapy than in those who did not (p < 0.001). In a multivariate Cox proportional hazard regression analysis, RAI-avid mLN appeared to be a robust risk factor for recurrent disease after the initial therapy (HR: 8.967, 95% CI: 3.433−23.421, p = 0.000). RAI-avid mLN is a significant risk factor for recurrent intermediate-risk PTC after the initial treatment.
甲状腺乳头状癌（PTC）的中危类别包含处于广泛分期范围且护理管理各异的异质性患者。应着重了解初始治疗后观察到的复发风险特征。我们旨在评估在初始治疗期间观察到的放射性碘摄取阳性淋巴结对被认为处于中危的PTC患者的预后意义。回顾性分析了2012年至2018年接受治疗的中危PTC患者的数据。对纳入患者的治疗后SPECT/CT（Rx SPECT/CT）进行了评估。回顾了Rx SPECT/CT上的临床、病理以及放射性碘摄取阳性（RAI摄取阳性）淋巴结转移（mLN）的发生率，并分析了与疾病复发相关的危险因素。在中位随访37.26（30.90，46.33）个月后，9.81%（36/367）的中危肿瘤患者检测到结构性持续性/复发性疾病。初始治疗后显示RAI摄取阳性mLN的患者复发率高于未显示的患者（p < 0.001）。在多变量Cox比例风险回归分析中，RAI摄取阳性mLN似乎是初始治疗后疾病复发的一个有力危险因素（HR：8.967，95% CI：3.433−23.421，p = 0.000）。RAI摄取阳性mLN是初始治疗后中危PTC复发的一个重要危险因素。
