Jahanshahi Alireza, Asoodeh Sarshoori Atefeh, Rashidi Homeira, Zaman Ferdos, Moradi Leila
Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Department of Internal Medicine, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Int J Endocrinol Metab. 2023 Jan 24;21(1):e130434. doi: 10.5812/ijem-130434. eCollection 2023 Jan.
Accurate evaluation of response to treatment in differentiated thyroid cancer (DTC) is the sine qua non of preventing over-treatment in low-risk patients and implementing appropriate interventions in high-risk individuals.
This study aimed to assess the response to therapy in DTC patients based on dynamic stratification method.
In this cross-sectional study, 154 medical records of subjects with DTC (with at least 6 months after total thyroidectomy) and referred to endocrinology clinics in Ahvaz, Iran, from April 2020 to May 2021 were examined. Patients were stratified according to a dynamic risk stratification system (informed by their specific clinical, histopathological, and ultrasonography findings, and other diagnostic imagines) into four groups: Excellent response (ER), indeterminate response (IR), biochemical incomplete response (BIR), and structural incomplete response (SIR).
For a mean follow-up period of 28.59 months, excellent response to treatment was observed in 92 patients (59.7%), indeterminate response to treatment was found in 32 patients (20.8%), biochemical incomplete response was detected in 2 patients (1.3%), and structural incomplete response was seen in 28 patients (18.2%). In the group with low risk of recurrence, ER and IR were observed in 79.2% and 15.6% of the patients, respectively (P < 0.0001). In the group with an intermediate risk of recurrence, ER was found in 32% of the patients, while IR and SIR + BIR were seen in 34% and 34% of the patients, respectively (P < 0.0001). No cases of ER or IR were observed in the group with high risk (P = 0.001).
In sum, response to treatment significantly varied based on dynamic risk stratification, with ER being highest in the low-risk group, less likely in moderate risk group, and undetected in the high-risk group.
准确评估分化型甲状腺癌（DTC）的治疗反应是防止低风险患者过度治疗以及对高风险个体实施适当干预的必要条件。
本研究旨在基于动态分层方法评估DTC患者的治疗反应。
在这项横断面研究中，检查了2020年4月至2021年5月期间转诊至伊朗阿瓦士内分泌诊所的154例DTC患者（全甲状腺切除术后至少6个月）的病历。根据动态风险分层系统（依据其特定的临床、组织病理学和超声检查结果以及其他诊断影像）将患者分为四组：良好反应（ER）、不确定反应（IR）、生化不完全反应（BIR）和结构不完全反应（SIR）。
平均随访期为28.59个月，92例患者（59.7%）对治疗有良好反应，32例患者（20.8%）对治疗反应不确定，2例患者（1.3%）检测到生化不完全反应，28例患者（18.2%）出现结构不完全反应。在低复发风险组中，分别有79.2%和15.6%的患者出现ER和IR（P<0.0001）。在中度复发风险组中，32%的患者出现ER，而分别有34%和34%的患者出现IR以及SIR+BIR（P<0.0001）。高风险组未观察到ER或IR病例（P=0.001）。
总之，基于动态风险分层，治疗反应存在显著差异，ER在低风险组中最高，中度风险组中可能性较小，高风险组未检测到。
