Sun Yungang, Sun Qiaoling, Tian Jinyu, He Xiaochuan
Department of Nuclear Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China.
J Clin Endocrinol Metab. 2023 Oct 18;108(11):e1413-e1423. doi: 10.1210/clinem/dgad264.
The waiting time for radioactive iodine therapy (WRAIT) after total thyroidectomy (TT) in patients with papillary thyroid cancer (PTC) and lymph node metastases (N1) has not been sufficiently investigated for risk of adverse outcomes.
This work aimed to estimate the effect of WRAIT on the outcomes of disease persistence and recurrence among patients with N1 PTC and investigate factors predictive of delayed radioactive iodine therapy (RAIT).
This retrospective cohort study was conducted in a university hospital. A total of 909 patients with N1 PTC were referred for RAIT between 2014 and 2018. WRAIT is the duration between TT and initial RAIT. The optimal WRAIT threshold determined using recursive partitioning analysis was used to define early and delayed RAIT. The primary end point was tumor persistence/recurrence. We compared the outcomes of patients with early and delayed RAIT using inverse probability weighting based on the propensity score.
The WRAIT threshold that optimally differentiated worse long-term remission/excellent response outcomes was greater than 88 days (51% of our cohort; n = 464). WRAIT exceeding 88 days was associated with an augmented risk of disease persistence/recurrence (odds ratio, 2.47; 95% CI, 1.60-3.82) after adjustment. Predictors of delayed RAIT included residence in lower-income areas, reoperation before the initial RAIT, TT at a nonuniversity-affiliated hospital, multifocality, extrathyroidal extension, N1b disease, and pre-RAIT-stimulated thyroglobulin level less than 1 ng/mL.
Delayed RAIT beyond 88 days after TT in patients with N1 PTC independently increased the risk of disease persistence/recurrence. Evaluation of the predictive determinants of prolonged WRAIT may help target at-risk patients and facilitate interventions.
对于甲状腺乳头状癌（PTC）伴淋巴结转移（N1）患者，全甲状腺切除术后（TT）接受放射性碘治疗的等待时间（WRAIT）对不良结局风险的影响尚未得到充分研究。
本研究旨在评估WRAIT对N1期PTC患者疾病持续和复发结局的影响，并调查延迟放射性碘治疗（RAIT）的预测因素。
本回顾性队列研究在一家大学医院进行。2014年至2018年间，共有909例N1期PTC患者接受RAIT治疗。WRAIT是指TT至首次RAIT的持续时间。使用递归分割分析确定的最佳WRAIT阈值用于定义早期和延迟RAIT。主要终点是肿瘤持续/复发。我们使用基于倾向评分的逆概率加权法比较了早期和延迟RAIT患者的结局。
最佳区分较差长期缓解/良好反应结局的WRAIT阈值大于88天（占我们队列的51%；n = 464）。调整后，WRAIT超过88天与疾病持续/复发风险增加相关（优势比，2.47；95%CI，1.60 - 3.82）。延迟RAIT的预测因素包括居住在低收入地区、首次RAIT前再次手术、在非大学附属医院进行TT、多灶性、甲状腺外侵犯、N1b期疾病以及RAIT前刺激甲状腺球蛋白水平低于1 ng/mL。
N1期PTC患者TT后超过88天的延迟RAIT独立增加了疾病持续/复发的风险。评估WRAIT延长的预测决定因素可能有助于针对高危患者并促进干预措施。
