Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
Endocrine Division, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.
Horm Metab Res. 2024 Sep;56(9):641-648. doi: 10.1055/a-2318-5320. Epub 2024 May 21.
Thyroglobulin (Tg) is an important tool to evaluate the persistence and recurrence risk in differentiated thyroid cancer (DTC). We aimed to evaluate the correlation between pre-radioiodine therapy stimulated Tg (pre-RAI Tg) levels and the first response to treatment evaluation, and to establish a cut-off pre-RAI Tg threshold for predicting an initial excellent response. Retrospective cohort study of DTC patients who underwent total thyroidectomy and radioiodine therapy. Response to therapy was evaluated 6 to 24 months after initial therapy, and patients were classified as: excellent response (ER); indeterminate response (IndR) and incomplete response (IncR). Total patients: 166 among which 85.5% female with mean age of 47.6 ± 13 years. The ER had a significantly lower pre-RAI Tg in comparison to IndR (p<0.001) and IncR (p<0.001), and pre-RAI Tg were different between the IndR and IncR (p=0.02). A cut-off pre-RAI Tg value at 7.55ng/ml was obtained by receiver operating characteristics curve for differentiating ER from IndR and IncR. The area under curve was 0.832 (95% CI 0.76-0.91). In multivariate analysis, ATA low-risk (RR 1.61, 95% CI 1.06-2.43, p=0.025) and Tg below 7.55ng/ml (RR 2.17, 95% CI 1.52-3.10, p<0.001) were associated with ER. After a median of 7.4-year follow-up, 124 (74.7%) patients were allocated into ER, 22 (13.2%) into IndR, and 20 (12%) into IncR. In conclusion, pre-RAI Tg predicts first evaluation of treatment response. Pre-RAI Tg cut-off was a key predictor of initial excellent response to therapy and may be an important tool in the follow-up of DTC patients.
甲状腺球蛋白（Tg）是评估分化型甲状腺癌（DTC）持续性和复发风险的重要工具。我们旨在评估放射性碘治疗前刺激 Tg（pre-RAI Tg）水平与首次治疗反应评估之间的相关性，并建立一个 pre-RAI Tg 截断值，以预测初始良好反应。这是一项回顾性队列研究，纳入了接受甲状腺全切除术和放射性碘治疗的 DTC 患者。治疗后 6-24 个月评估治疗反应，患者分为：完全缓解（ER）；不确定反应（IndR）和不完全缓解（IncR）。总患者数：166 例，其中 85.5%为女性，平均年龄为 47.6 ± 13 岁。与 IndR（p<0.001）和 IncR（p<0.001）相比，ER 的 pre-RAI Tg 明显较低，IndR 和 IncR 之间的 pre-RAI Tg 也不同（p=0.02）。通过接受者操作特征曲线获得区分 ER 与 IndR 和 IncR 的预放射性碘治疗 Tg 截断值为 7.55ng/ml。曲线下面积为 0.832（95%CI 0.76-0.91）。在多变量分析中，ATA 低危（RR 1.61，95%CI 1.06-2.43，p=0.025）和 Tg 低于 7.55ng/ml（RR 2.17，95%CI 1.52-3.10，p<0.001）与 ER 相关。中位随访 7.4 年后，124 例（74.7%）患者被分配到 ER，22 例（13.2%）分到 IndR，20 例（12%）分到 IncR。总之，pre-RAI Tg 可预测治疗反应的首次评估。预放射性碘治疗 Tg 截断值是预测初始治疗良好反应的关键指标，可能是 DTC 患者随访的重要工具。
