Son Junik, Hong Chae Moon, Kim Do-Hoon, Jeong Shin Young, Lee Sang-Woo, Lee Jaetae, Ahn Byeong-Cheol
Department of Nuclear Medicine, Kyungpook National University Hospital, 130 Dongdeok-Ro, Jung Gu, Daegu, Republic of Korea 41944.
Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Nucl Med Mol Imaging. 2023 Dec;57(6):257-264. doi: 10.1007/s13139-023-00811-8. Epub 2023 Jul 3.
The growing incidence of differentiated thyroid cancer (DTC) demands dependable prognostic factors to guide follow-up and treatment plans. This study investigated the prognostic value of response to therapy (RTT) assessment using TSH stimulated-thyroglobulin (sti-Tg) and nonstimulated-thyroglobulin (nonsti-Tg) and evaluates whether RTT using nonsti-Tg (nonstiRTT) can replace RTT using sti-Tg (stiRTT) in clinical practice to improve patients' quality of life during assessment.
We enrolled 419 DTC patients who underwent total thyroidectomy, radioactive iodine (RAI) therapy, and Tg assessment. Patients with structural incomplete responses were excluded. Initial RTT assessments based on the 2015 American Thyroid Association guidelines (excellent response; ER, indeterminate response, biochemical incomplete response) were performed 6-24 months after RAI therapy. The second RTT assessments were performed 6-24 months after the first assessment. Statistical analysis for recurrence-free survival (RFS) was done with the log-rank test for stiRTT and nonstiRTT.
Although initial stiRTT and nonstiRTT were significant predictors for RFS (p < 0.0001), stiRTT provided better RFS prediction than nonstiRTT. The RFS analysis of the second RTT assessment demonstrated statistical significance only for stiRTT (p < 0.0001). In 116 patients classified as ER on initial stiRTT, there was no RFS difference between patients classified as ER on either second stiRTT or nonstiRTT.
The prognostic power of stiRTT surpasses that of nonstiRTT in both the initial and second RTT assessment. Nevertheless, among patients classified as ER on initial stiRTT, a second stiRTT may not be required for those classified as ER on the second nonstiRTT.
The online version contains supplementary material available at 10.1007/s13139-023-00811-8.
分化型甲状腺癌（DTC）发病率不断上升，需要可靠的预后因素来指导随访和治疗方案。本研究调查了使用促甲状腺激素刺激甲状腺球蛋白（sti-Tg）和非刺激甲状腺球蛋白（nonsti-Tg）评估治疗反应（RTT）的预后价值，并评估在临床实践中使用nonsti-Tg的RTT（nonstiRTT）是否可以取代使用sti-Tg的RTT（stiRTT），以在评估期间提高患者的生活质量。
我们纳入了419例行全甲状腺切除术、放射性碘（RAI）治疗和Tg评估的DTC患者。排除结构上不完全缓解的患者。根据2015年美国甲状腺协会指南进行初始RTT评估（优秀反应；ER，不确定反应，生化不完全反应），在RAI治疗后6-24个月进行。第二次RTT评估在第一次评估后6-24个月进行。采用对数秩检验对stiRTT和nonstiRTT的无复发生存期（RFS）进行统计分析。
虽然初始stiRTT和nonstiRTT是RFS的显著预测因素（p < 0.0001），但stiRTT比nonstiRTT提供了更好的RFS预测。第二次RTT评估的RFS分析仅显示stiRTT具有统计学意义（p < 0.0001）。在初始stiRTT分类为ER的116例患者中，第二次stiRTT或nonstiRTT分类为ER的患者之间无RFS差异。
在初始和第二次RTT评估中，stiRTT的预后能力均超过nonstiRTT。然而，在初始stiRTT分类为ER的患者中，第二次nonstiRTT分类为ER的患者可能不需要进行第二次stiRTT。
在线版本包含可在10.1007/s13139-023-00811-8获取的补充材料。
