Li Xinyang, Yan Lin, Xiao Jing, Li Yingying, Zhu Yaqiong, Yang Zhen, Zhang Mingbo, Luo Yukun
Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
School of Medicine, Nankai University, Tianjin, China.
Int J Hyperthermia. 2023;40(1):2160880. doi: 10.1080/02656736.2022.2160880.
Maintaining an optimal thyroid stimulating hormone (TSH) level is important in the postoperative management of papillary thyroid carcinoma (PTC). However, there is little evidence for TSH target levels in patients undergoing radiofrequency ablation (RFA). This study aimed to determine the optimal TSH level for management in low-risk patients who underwent RFA.
This retrospective propensity score-matched cohort study included patients with low-risk PTC who underwent RFA from January 2014 to December 2018. The patients were categorized into two groups based on the range of TSH levels: low (≤2 mU/L) and high (>2 mU/L) TSH levels. Local tumor progression and disease-free survival (DFS) were compared between the low TSH and high TSH groups, using propensity score analyses based on patient- and tumor-level characteristics. Univariate analyses were performed to select risk factors for tumor progression.
Overall, our study included 516 patients with low-risk PTC who underwent RFA with a long-term follow-up of 5-years. During follow-up, the overall incidence rate of local tumor progression was 4.8% (25/516), with no significant difference between the matched groups (7/106 [6.6%] vs. 5/53 [9.4%], = 0.524). DFS did not differ between the two groups ( = 0.5). Moreover, TSH level was not regarded as a significant predictor of tumor progression after Cox analysis; primary tumor size was the only relevant risk factor.
This large propensity-matched study revealed no association between TSH levels and tumor progression. Thus, for patients with low-risk PTC who underwent RFA, the optimalTSH level is recommended at the euthyroid range.
维持最佳促甲状腺激素（TSH）水平在甲状腺乳头状癌（PTC）术后管理中至关重要。然而，对于接受射频消融（RFA）的患者，几乎没有关于TSH目标水平的证据。本研究旨在确定接受RFA的低风险患者管理的最佳TSH水平。
这项回顾性倾向评分匹配队列研究纳入了2014年1月至2018年12月期间接受RFA的低风险PTC患者。根据TSH水平范围将患者分为两组：低TSH水平（≤2 mU/L）和高TSH水平（>2 mU/L）。使用基于患者和肿瘤水平特征的倾向评分分析，比较低TSH组和高TSH组之间的局部肿瘤进展和无病生存期（DFS）。进行单因素分析以选择肿瘤进展的危险因素。
总体而言，我们的研究纳入了516例接受RFA的低风险PTC患者，并进行了5年的长期随访。随访期间，局部肿瘤进展的总发生率为4.8%（25/516），匹配组之间无显著差异（7/106 [6.6%] 对5/53 [9.4%]，P = 0.524）。两组之间的DFS无差异（P = 0.5）。此外，Cox分析后TSH水平不被视为肿瘤进展的显著预测因素；原发肿瘤大小是唯一相关的危险因素。
这项大型倾向匹配研究表明TSH水平与肿瘤进展之间无关联。因此，对于接受RFA的低风险PTC患者，建议将最佳TSH水平维持在甲状腺功能正常范围内。
