Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
Department of Internal Medicine, Fujian Provincial Hospital South Branch, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
Endocrine. 2024 Nov;86(2):664-671. doi: 10.1007/s12020-024-03869-2. Epub 2024 May 29.
The 2015 American Thyroid Association (ATA) guidelines proposed the use of the ATA Risk Stratification System and American Joint Committee on Cancer Tumor-Node-Metastasis (AJCC/TNM) Staging System for postoperative radioiodine decision-making. However, the management of patients with intermediate-risk differentiated thyroid carcinoma (DTC) is not well defined. In this study, we aimed to evaluate the therapeutic efficacy of radioactive iodine therapy (RAIT) among various subgroups of patients with intermediate-risk DTC after surgery.
This was a retrospective study based on the Surveillance, Epidemiology, and End Results (SEER) database (2010-2015). The DTC patients with intermediate risk of recurrence were divided into two groups (treated or not treated with radioactive iodine (RAI)). As the treatment was not randomly assigned, stabilized inverse probability treatment weighting (sIPTW) was used to reduce selection bias. We used the Kaplan-Meier method and log-rank test to analyze overall survival (OS) and cancer-specific survival (CSS).
Kaplan-Meier analysis after sIPTW found a significant difference in OS and CSS between no RAIT and RAIT (log-rank test, P < 0.0001; P = 0.0019, respectively). The Kaplan-Meier curves of CSS in age cutoff of 55 years showed a significant association between no RAIT and RAIT (log-rank test, P = 0.0045). Univariate and multivariate Cox regression showed RAIT was associated with a reduced risk of mortality compared with no RAIT (hazard ratio [HR] 0.59, 95% confidence interval [95% CI 0.44-0.80]). Age (≥ 55) years showed a worse CSS regardless of whether or not a patient was treated or not treated with RAI ([HR] 8.91, 95% confidence interval [95% CI 6.19-12.84]).
RAIT improves OS and CSS in patients with intermediate-risk DTC after surgery. 55 years is a more appropriate prognostic age cutoff for the relevant classification systems and is a crucial consideration in RAI decision-making. Therefore, we need individualized treatment plans.
2015 年美国甲状腺协会（ATA）指南建议使用 ATA 风险分层系统和美国癌症联合委员会肿瘤-淋巴结-转移（AJCC/TNM）分期系统来决定术后放射性碘治疗（RAIT）。然而，对于中危分化型甲状腺癌（DTC）患者的管理尚未明确。本研究旨在评估术后中危 DTC 患者接受 RAIT 的疗效。
这是一项基于监测、流行病学和最终结果（SEER）数据库（2010-2015 年）的回顾性研究。将复发风险为中危的 DTC 患者分为两组（治疗组和未治疗组）。由于治疗并非随机分配，因此采用稳定逆概率治疗加权（sIPTW）来减少选择偏倚。我们使用 Kaplan-Meier 方法和对数秩检验来分析总生存期（OS）和癌症特异性生存期（CSS）。
sIPTW 后的 Kaplan-Meier 分析发现，无 RAIT 和有 RAIT 之间的 OS 和 CSS 差异有统计学意义（对数秩检验，P<0.0001；P=0.0019）。Kaplan-Meier 曲线分析发现，年龄截点为 55 岁时，无 RAIT 和有 RAIT 之间的 CSS 存在显著关联（对数秩检验，P=0.0045）。单因素和多因素 Cox 回归分析显示，与无 RAIT 相比，RAIT 与降低死亡率相关（风险比[HR]0.59，95%置信区间[95%CI 0.44-0.80]）。无论患者是否接受 RAIT，年龄（≥55 岁）均与较差的 CSS 相关（HR 8.91，95%CI 6.19-12.84）。
RAIT 可改善术后中危 DTC 患者的 OS 和 CSS。55 岁是相关分类系统更合适的预后年龄截点，是 RAIT 决策的关键考虑因素。因此，我们需要个体化治疗方案。
