Dong Wen-Wu, Zhang Da-Lin, He Liang, Shao Liang, Wang Zhi-Hong, Lv Cheng-Zhou, Zhang Ping, Huang Tao, Zhang Hao
Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China.
Department of Breast and Thyroid Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Oncol. 2022 Jul 4;12:840714. doi: 10.3389/fonc.2022.840714. eCollection 2022.
Prognostic factors for excellent response (ER) to initial therapy in patients with papillary thyroid cancer (PTC) have not been determined. In this study, we investigated the response to initial therapy in PTC patients and independent prognostic factors for ER in a prospective multicenter study in China. A total of 506 PTC patients from nine centers in China were enrolled in this study, all of whom underwent total or near total thyroidectomy with lymph node dissection and subsequent radioiodine therapy. Univariate and multivariable logistic regression analyses were carried out to determine the independent prognostic factors for ER. The optimal cutoff value of the number of metastatic lymph nodes for predicting ER was determined by the receiver operating characteristic curve. A total of 139 patients (27.5%) achieved ER after initial therapy. Extrathyroidal extension, the number of metastatic lymph nodes, and preablative-stimulated thyroglobulin (Ps-Tg) were independent risk factors for ER for the entire population. In a subgroup analysis, extrathyroidal extension and Ps-Tg were independent risk factors for ER in pathological N1a patients, while the number of metastatic lymph nodes and Ps-Tg were independent risk factors for ER in pathological N1b patients. The appropriate cutoff values of the number of metastatic lymph nodes in predicting ER were 5 and 13 for the entire population and pathological N1b PTC patients, respectively. PTC patients with more metastatic lymph nodes were more likely to fail to achieve ER. Extrathyroidal extension, the number of metastatic lymph nodes, and Ps-Tg were important prognostic factors for ER after initial therapy in PTC patients.
甲状腺乳头状癌（PTC）患者对初始治疗产生优异反应（ER）的预后因素尚未确定。在本研究中，我们在中国一项前瞻性多中心研究中调查了PTC患者对初始治疗的反应以及ER的独立预后因素。本研究共纳入了来自中国9个中心的506例PTC患者，所有患者均接受了全甲状腺切除术或近全甲状腺切除术加淋巴结清扫术以及随后的放射性碘治疗。进行单因素和多因素逻辑回归分析以确定ER的独立预后因素。通过受试者工作特征曲线确定预测ER的转移淋巴结数量的最佳截断值。共有139例患者（27.5%）在初始治疗后达到ER。甲状腺外侵犯、转移淋巴结数量和消融前刺激甲状腺球蛋白（Ps-Tg）是整个人群ER的独立危险因素。在亚组分析中，甲状腺外侵犯和Ps-Tg是病理N1a患者ER的独立危险因素，而转移淋巴结数量和Ps-Tg是病理N1b患者ER的独立危险因素。预测ER的转移淋巴结数量的适当截断值在整个人群和病理N1b PTC患者中分别为5个和13个。转移淋巴结较多的PTC患者更有可能无法达到ER。甲状腺外侵犯、转移淋巴结数量和Ps-Tg是PTC患者初始治疗后ER的重要预后因素。
