Department of Nuclear Medicine, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
Front Endocrinol (Lausanne). 2023 May 30;14:1099449. doi: 10.3389/fendo.2023.1099449. eCollection 2023.
Residual/recurrent lymph node metastase (LNM) is often found after differentiated thyroid cancer (DTC) surgery. This study aimed to investigate whether patients complicated with radioiodine-avid (I+) lymph nodes from DTC on the initial posttherapy scan (PTS) need repeated I therapy.
From June 2013 to August 2022, DTC patients with I+ lymph nodes on the initial PTS who received at least two cycles of I therapy were retrospectively enrolled. They were divided into a complete response (CR) group and an incomplete response (IR) group according to their response to the initial I therapy based on the 2015 American Thyroid Association (ATA) guidelines.
A total of 170 DTC patients with I+ lymph nodes on the initial PTS were included; 42/170 (24.7%) patients were classified into the CR group and 128/170 (75.9%) were classified into the IR group according to their response to the initial I therapy. None of the 42 CR patients had disease progression at the subsequent follow-up, and 37/170 (21.8%) IR patients improved after repeated therapy. Univariate analysis showed that N stage (0.002), stimulated thyroglobulin (sTg) level before initial I therapy (<0.001), LNM size (<0.001), number of total residual/recurrent LNM (0.021), radioiodine-nonavid (I-) LNM (0.002) and ultrasound features (<0.001) were related to the initial treatment response. On multivariate analysis, sTg level (=1.186, <0.001) and LNM size (=1.533, =0.004) were independent risk factors for IR after initial I therapy. The optimal sTg level and LNM size cutoff value for predicting the treatment response after initial I therapy were 18.2 µg/l and 5mm.
This study suggested that approximately one-quarter of patients with I+ lymph nodes on initial PTS, especially those with N0 or N1a stage, lower sTg level, smaller LNM size, ≤2 residual/recurrent LNMs, negative ultrasound features and no I- LNM, remain stable after one cycle of I therapy and do not need repeated therapy.
分化型甲状腺癌（DTC）术后常发现残留/复发性淋巴结转移（LNM）。本研究旨在探讨初始治疗后扫描（PTS）显示碘-131 阳性（I+）淋巴结的 DTC 患者是否需要重复 I 治疗。
回顾性纳入 2013 年 6 月至 2022 年 8 月间至少接受两个周期 I 治疗且 PTS 时 I+淋巴结的 DTC 患者。根据 2015 年美国甲状腺协会（ATA）指南，根据初始 I 治疗的反应，将其分为完全缓解（CR）组和不完全缓解（IR）组。
共纳入 170 例 PTS 时 I+淋巴结的 DTC 患者；42/170（24.7%）患者根据初始 I 治疗的反应被分为 CR 组，128/170（75.9%）患者被分为 IR 组。42 例 CR 患者在随后的随访中均无疾病进展，37/170（21.8%）例 IR 患者经重复治疗后改善。单因素分析显示，N 分期（0.002）、初始 I 治疗前促甲状腺球蛋白（sTg）水平（<0.001）、LNM 大小（<0.001）、总残留/复发性 LNM 数（0.021）、非碘-131 摄取（I-）LNM（0.002）和超声特征（<0.001）与初始治疗反应相关。多因素分析显示，sTg 水平（=1.186，<0.001）和 LNM 大小（=1.533，=0.004）是初始 I 治疗后 IR 的独立危险因素。预测初始 I 治疗后治疗反应的最佳 sTg 水平和 LNM 大小截断值分别为 18.2μg/L 和 5mm。
本研究表明，初始 PTS 时 I+淋巴结的患者中，约四分之一，尤其是 N0 或 N1a 期、sTg 水平较低、LNM 较小、≤2 个残留/复发性 LNM、超声特征阴性且无 I- LNM 的患者，在一个周期 I 治疗后保持稳定，无需重复治疗。
