Zhao Hao, Liu Chun-Hao, Cao Yue, Zhang Li-Yang, Zhao Ya, Zhang Xin, Lin Yan-Song, Xia Yu, Liu Yue-Wu, Liu Hong-Feng, Li Xiao-Yi
Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Front Oncol. 2022 Aug 12;12:947710. doi: 10.3389/fonc.2022.947710. eCollection 2022.
Radioiodine (RAI) therapy plays a vital role in the postoperative treatment of differentiated thyroid cancer (DTC) patients underwent total thyroidectomy (TT). However, even in the presence of capsular invasion and lymph node metastasis prognosis can be excellent and a postoperative RAI treatment might not be necessary for all patients. Therefore, this study explored the criteria for avoiding unnecessary RAI therapy in these patients.
We applied response to therapy assessment immediately after surgery and prospectively recruited 179 excellent or indeterminate response DTC patients with capsular invasion and/or LNM who underwent TT without RAI therapy. During the follow-up, thyroglobulin (Tg), thyroglobulin antibody (TgAb) levels, and cervical ultrasonography were collected and analyzed. Disease-free survival (DFS) was calculated using the Kaplan-Meier method. In addition, response to therapy assessments was performed on patients during each follow-up.
The mean follow-up period was 29.85 ± 17.44 months, and the 3- and 5-year DFS for all the patients was 99.3% in each. At the last follow-up, 165 (92.2%) patients had excellent responses, while 12 (6.7%) had an indeterminate response, and one (0.6%) each had biochemical and incomplete responses. No significant difference was observed in response to therapy between the subgroups of LNM and tumor invasion (P>0.05). For patients with capsular invasion and a number of metastatic lymph nodes ≤5 and >5, the proportions of recorded excellent responses were 95.9%, 91.0%, and 85.7%, respectively. Better responses were observed in females (excellent response: 95.5%, P=0.023), patients with stimulated Tg (s-Tg) ≤1ng/ml (excellent response: 100%, P<0.001), s-Tg ≤ 2ng/ml (excellent response: 98.4%, P<0.001), and excellent response for the immediate postoperative assessment (excellent response: 98.5%, P=0.004).
The current study suggested that the response to therapy assessment immediately applied postoperatively could help avoid unnecessary RAI therapy among DTC patients with capsular invasion and/or LNM. Moreover, excellent response patients and patients with indeterminate response and s-Tg ≤ 2ng/ml could be managed without RAI therapy.
放射性碘（RAI）治疗在接受全甲状腺切除术（TT）的分化型甲状腺癌（DTC）患者的术后治疗中起着至关重要的作用。然而，即使存在包膜侵犯和淋巴结转移，预后也可能良好，并非所有患者都需要术后RAI治疗。因此，本研究探讨了避免这些患者接受不必要的RAI治疗的标准。
我们在手术后立即进行治疗反应评估，并前瞻性招募了179例具有包膜侵犯和/或淋巴结转移（LNM）、接受TT且未接受RAI治疗的反应良好或不确定的DTC患者。在随访期间，收集并分析甲状腺球蛋白（Tg）、甲状腺球蛋白抗体（TgAb）水平及颈部超声检查结果。采用Kaplan-Meier法计算无病生存期（DFS）。此外，在每次随访时对患者进行治疗反应评估。
平均随访期为29.85±17.44个月，所有患者的3年和5年DFS均为99.3%。在最后一次随访时，165例（92.2%）患者反应良好，12例（6.7%）反应不确定，各有1例（0.6%）出现生化反应和不完全反应。LNM和肿瘤侵犯亚组之间的治疗反应无显著差异（P>0.05）。对于有包膜侵犯且转移淋巴结数量≤5个和>5个的患者，记录的良好反应比例分别为95.9%、91.0%和85.7%。女性（良好反应：95.5%，P=0.023）、刺激后Tg（s-Tg）≤1ng/ml的患者（良好反应：100%，P<0.001）、s-Tg≤2ng/ml的患者（良好反应：98.4%，P<0.001）以及术后立即评估为良好反应的患者（良好反应：98.5%，P=0.004）观察到更好的反应。
本研究表明，术后立即进行的治疗反应评估有助于避免有包膜侵犯和/或LNM的DTC患者接受不必要的RAI治疗。此外，反应良好的患者以及反应不确定且s-Tg≤2ng/ml的患者可以不接受RAI治疗。
