Attia Amina, Touma Eliane, Lussey-Lepoutre Charlotte, Ghander Cécile, Jouinot Anne, Roy Malanie, Housni Selma, Chereau Nathalie, Menegaux Fabrice, Leenhardt Laurence, Buffet Camille
Service des Pathologies Thyroïdiennes et Tumorales Endocrines, Hôpital Universitaire Pitié Salpêtrière, Paris, France.
Hôpital Universitaire Pitié Salpêtrière, Service des Pathologies Thyroïdiennes et Tumorales Endocrines, 75013 Paris, France.
Thyroid. 2024 Dec;34(12):1465-1475. doi: 10.1089/thy.2024.0119. Epub 2024 Oct 14.
The current dogma is a life-long follow-up for patients treated for follicular-derived differentiated thyroid cancers (DTC). Our primary objective was to determine the time to recurrence in a series of DTC patients with an excellent response to therapy 6 months after total thyroidectomy and radioiodine therapy. The secondary objectives were to determine the time to suspicion of recurrence and to identify factors associated with recurrence. This retrospective cohort study included patients treated for DTC between 2008 and 2012 and in remission 6 months after total thyroidectomy and radioiodine treatment. The criteria for remission were negative imaging and suppressed thyroglobulin (Tg) <0.2 ng/mL or rh-TSH-(recombinant human TSH) stimulated Tg <1 ng/mL according to the 2015 ATA (American Thyroid Association) guidelines. Recurrence was defined by cytologically and/or histologically proven cervical lymph node metastasis or the administration of a second radioiodine treatment. Among 721 patients treated for DTC, 158 were excluded because of persistent disease at 6 months, 71 because of missing follow-up data, and 492 were included. The mean and median follow-up time were 7.0 and 7.9 years (interquartile range IQR [2.1-11.3]). Recurrence occurred for 7 patients (1.4%), 1 initially classified as high recurrence risk, 3 as intermediate, and 3 as low risk according to the 2015 ATA guidelines. All relapses occurred within 10 years after initial management (4 within the first 5 years). For patients with recurrence, rise in Tg and/or suspicious lymph nodes were detected in six out of seven cases in the first 8 years and for the last case 10 years after initial surgery. Low and intermediate recurrence risk DTC patients with excellent response 6 months after total thyroidectomy and radioiodine and in remission 10 years later have an extremely low recurrence risk. Follow-up might be undertaken by primary care providers from this time point. These discharge recommendations should be confirmed by further prospective studies.
目前的教条是对滤泡性分化型甲状腺癌（DTC）患者进行终身随访。我们的主要目标是确定一系列在全甲状腺切除和放射性碘治疗6个月后对治疗反应良好的DTC患者的复发时间。次要目标是确定疑似复发的时间，并识别与复发相关的因素。这项回顾性队列研究纳入了2008年至2012年间接受DTC治疗且在全甲状腺切除和放射性碘治疗6个月后处于缓解期的患者。缓解标准根据2015年美国甲状腺协会（ATA）指南，影像学检查阴性且甲状腺球蛋白（Tg）抑制水平<0.2 ng/mL，或重组人促甲状腺素（rh-TSH）刺激后的Tg<1 ng/mL。复发定义为经细胞学和/或组织学证实的颈部淋巴结转移或进行第二次放射性碘治疗。在721例接受DTC治疗的患者中，158例因6个月时疾病持续存在而被排除，71例因随访数据缺失而被排除，492例被纳入研究。平均随访时间和中位随访时间分别为7.0年和7.9年（四分位间距IQR[2.1 - 11.3]）。7例患者（1.4%）出现复发，根据2015年ATA指南，1例最初被分类为高复发风险，3例为中复发风险，3例为低复发风险。所有复发均发生在初始治疗后的10年内（4例发生在头5年内）。对于复发患者，7例中有6例在最初手术的前8年内检测到Tg升高和/或可疑淋巴结，最后1例在初始手术后10年检测到。全甲状腺切除和放射性碘治疗6个月后反应良好且10年后处于缓解期的低复发风险和中复发风险DTC患者复发风险极低。从这个时间点起，初级保健提供者可进行随访。这些出院建议应通过进一步的前瞻性研究加以证实。
