Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889, (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina.
Endocrine. 2023 Jun;80(3):606-611. doi: 10.1007/s12020-023-03306-w. Epub 2023 Mar 29.
In patients with low-risk differentiated thyroid cancer (DTC), remnant ablation with radioiodine (RA) after total thyroidectomy (TT) is controversial. No benefits have been demonstrated in terms of mortality or disease-free survival. Recent evidence found that RA did not improve mid-term outcomes.
To evaluate initial response to treatment and long-term follow-up status in low-risk DTC patients after TT vs. TT + RA with I 1.11 GBq (30 mCi).
Prospective multicenter non-randomized study; 174 low-risk DTC that underwent TT were recruited an divided in two groups according to RA (87 ablated and 87 non-ablated). Response to treatment was evaluated at 6-18 months after thyroidectomy and at the end of follow-up with measurements of thyroglobulin, and anti-thyroglobulin antibodies levels, and neck ultrasonography.
Baseline characteristics of both groups were similar. Ablated patients: median age 45.5 years, 84% females, 95.4% papillary thyroid carcinoma (PTC), mean tumor size 16 mm; non-ablated: median age 45 years, 88.5% females, 96.6% PTC, mean tumor size 14 mm. Response to initial treatment was similar between both groups, with < 2% of structural incomplete response. Final status was evaluated in 139 cases (median follow-up of 60 months). Among ablated patients, 82.8% had no evidence of disease (NED), 12% had an indeterminate response (IR) and 5% a biochemical incomplete response (BIR). Non-ablated patients had NED in 90%, IR in 8.7% and BIR in 1.2%. No statistical difference was found between groups (p = 0.29). No patient had evidence of structural disease at the end of follow-up.
Our findings support the recommendation against routine RA in low-risk DTC patients.
对于低危分化型甲状腺癌（DTC）患者，甲状腺全切术后进行放射性碘（RA）清甲治疗尚存争议。目前并无证据表明该治疗可降低死亡率或改善无病生存率。近期研究发现，RA 并不能改善中期预后。
评估低危 DTC 患者甲状腺全切术（TT）后与 TT+111GBq（30mCi）RA 治疗后的初始治疗应答和长期随访结果。
前瞻性多中心非随机研究；共纳入 174 例低危 DTC 患者，根据是否行 RA 治疗分为两组（87 例行 RA 治疗，87 例未行 RA 治疗）。治疗应答评估在甲状腺切除术后 6-18 个月进行，随访结束时通过测量甲状腺球蛋白（Tg）和抗甲状腺球蛋白抗体（TgAb）水平及颈部超声进行评估。
两组患者的基线特征相似。RA 治疗组患者的中位年龄为 45.5 岁，84%为女性，95.4%为甲状腺乳头状癌（PTC），肿瘤平均直径为 16mm；未行 RA 治疗组患者的中位年龄为 45 岁，88.5%为女性，96.6%为 PTC，肿瘤平均直径为 14mm。两组患者的初始治疗应答无显著差异，结构不完全应答比例均＜2%。最终状态评估共纳入 139 例患者（中位随访时间 60 个月）。RA 治疗组中，82.8%的患者无疾病证据（NED），12%为不确定应答（IR），5%为生化不完全应答（BIR）；未行 RA 治疗组中，90%的患者为 NED，8.7%为 IR，1.2%为 BIR。两组间差异无统计学意义（p=0.29）。随访结束时，两组患者均无结构疾病证据。
本研究结果支持不常规推荐低危 DTC 患者行 RA 治疗。
