甲状腺球蛋白自身抗体在接受乐伐替尼治疗的甲状腺癌患者中的意义

Significance of Thyroglobulin Autoantibodies in Patients With Thyroid Cancer Treated With Lenvatinib.

作者信息

Sgrò Daniele, Rossi Piercarlo, Piaggi Paolo, Brancatella Alessandro, Lorusso Loredana, Bottici Valeria, Molinaro Eleonora, Latrofa Francesco, Elisei Rossella, Agate Laura

机构信息

Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56127, Italy.

Radiology, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa 56127, Italy.

出版信息

J Endocr Soc. 2023 Jul 10;7(8):bvad084. doi: 10.1210/jendso/bvad084. eCollection 2023 Jul 3.

DOI:10.1210/jendso/bvad084

PMID:37440964

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10334479/

Abstract

CONTEXT

Serum thyroglobulin (Tg) is a highly sensitive and specific tumor marker, employed in post-operative management of patients with differentiated thyroid carcinomas. Tumor shrinkage of radioiodine-refractory thyroid cancer (RAIR-DTC) treated with multitarget kinase inhibitors as lenvatinib, expressed according to the Response Evaluation Criteria in Solid Tumors (RECIST), is also associated with a drastic reduction of Tg levels. However, interference caused by circulating thyroglobulin autoantibodies (TgAb) represents the main limitation in the clinical use of Tg.

OBJECTIVE

To evaluate if in RAIR-DTC TgAb could be considered a surrogate marker of Tg in monitoring response to treatment with lenvatinib.

DESIGN

We retrospectively evaluated patients who had started lenvatinib and correlated serum Tg and TgAb with the radiological response across visits.

SETTING

University of Pisa, Italy.

PATIENTS

We selected 9/97 RAIR-DTC patients with detectable TgAb.

INTERVENTION

None.

MAIN OUTCOME MEASURES

None.

RESULTS

Tg values correlated neither with TgAb title nor with radiological response across visits. Greater decreases in TgAb titer correlated with favorable radiological response to lenvatinib after 1 month (Spearman's correlation = 0.74, = .021) and 6 months (correlation = 0.61, = .079). According to RECIST, patients with partial response showed a ∼10-fold greater decrease in TgAb compared to those with stable disease at 1 month (median TgAb decrease: -142 vs -14 IU/mL, = .01) and those with progressive disease at 6 months (median TgAb decrease: -264 vs-24 IU/mL, = .04).

CONCLUSION

TgAb evaluation may represent a reliable surrogate marker for Tg trend in evaluating response of RAIR-DTC to treatment with lenvatinib. A multicentric study would be useful to confirm our results.

摘要

背景

血清甲状腺球蛋白（Tg）是一种高度敏感且特异的肿瘤标志物，用于分化型甲状腺癌患者的术后管理。用多靶点激酶抑制剂（如乐伐替尼）治疗的放射性碘难治性甲状腺癌（RAIR-DTC）的肿瘤缩小情况，根据实体瘤疗效评价标准（RECIST）评估，也与Tg水平的大幅降低相关。然而，循环甲状腺球蛋白自身抗体（TgAb）引起的干扰是Tg临床应用中的主要限制因素。

目的

评估在RAIR-DTC中，TgAb是否可被视为监测乐伐替尼治疗反应时Tg的替代标志物。

设计

我们回顾性评估了开始使用乐伐替尼的患者，并将血清Tg和TgAb与各次就诊时的放射学反应进行关联分析。

地点

意大利比萨大学。

患者

我们从97例RAIR-DTC患者中选取了9例可检测到TgAb的患者。

干预措施

无。

主要观察指标

无。

结果

Tg值与TgAb水平以及各次就诊时的放射学反应均无相关性。TgAb滴度的更大降幅与1个月（Spearman相关系数 = 0.74，P = 0.021）和6个月（相关系数 = 0.61，P = 0.079）时对乐伐替尼的良好放射学反应相关。根据RECIST标准，部分缓解的患者在1个月时TgAb的下降幅度比病情稳定的患者大10倍左右（TgAb下降中位数：-142 vs -14 IU/mL，P = 0.01），在6个月时比疾病进展的患者大10倍左右（TgAb下降中位数：-264 vs -24 IU/mL，P = 0.04）。