Liu Yanlin, Huang Shuhui, Li Xiaohui, Tian Tian, Huang Rui
Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China.
Endocrine. 2025 Feb;87(2):734-743. doi: 10.1007/s12020-024-04064-z. Epub 2024 Oct 9.
Successful ablation in I therapy for differentiated thyroid cancer (DTC) includes both remnant ablation (RA) and radioiodine adjuvant therapy (RAT). This study aimed to differentiate between the therapeutic efficacies of RA and RAT, investigate the factors associated with their effectiveness, and assess their impact on prognosis.
This retrospective study included patients with DTC who underwent initial I therapy at our tertiary center. The successful RA (SRA) and successful RAT (SRAT) was determined based on the I-diagnostic whole-body scan (Dx-WBS), TSH-stimulated thyroglobulin (sTg) levels, and neck ultrasound at the 6th month after I therapy. The patients were divided into complete response and persistent/recurrent disease groups during the follow-up period.
A total of 232 patients were included, 91.8% (213/232) of patients achieved SRA, only 8.1% (19/232) failed RA (FRA). Among the 213 patients in the SRA group, 70.4% (150/213) achieved SRAT and 29.6% (63/213) failed RAT (FRAT). Only pre-ablation sTg >10 ng/mL (OR = 46.968, 95% CI 9.731-226.699, P < 0.001) was an independent risk factor predicting the failure of RAT. The prognostic analysis included 215 patients, and 6.1% (13/215) were classified as persistent/recurrent disease at the last follow-up. Both pre-ablation sTg >10 ng/mL (HR = 4.765, 95% CI 1.371-16.566, P = 0.014) and FRAT (HR = 10.104, 95% CI 1.071-95.304, P = 0.043) independently predicted persistent/recurrent disease.
RA is easy to achieve successfully, whereas RAT evaluation provides greater value than RA for prognosis prediction. For patients with low Tg levels and no imaging evidence of disease, routine Dx-WBS during follow-up has minimal significance.
分化型甲状腺癌（DTC）碘治疗中的成功消融包括残余甲状腺组织消融（RA）和放射性碘辅助治疗（RAT）。本研究旨在区分RA和RAT的治疗效果，探究与其疗效相关的因素，并评估其对预后的影响。
这项回顾性研究纳入了在我们三级中心接受初次碘治疗的DTC患者。根据碘诊断全身扫描（Dx-WBS）、促甲状腺激素刺激甲状腺球蛋白（sTg）水平以及碘治疗后第6个月的颈部超声检查来确定成功的RA（SRA）和成功的RAT（SRAT）。在随访期间将患者分为完全缓解组和持续/复发疾病组。
共纳入232例患者，91.8%（213/232）的患者实现了SRA，仅8.1%（19/232）的患者RA失败（FRA）。在SRA组的213例患者中，70.4%（150/213）实现了SRAT，29.6%（63/213）的患者RAT失败（FRAT）。仅消融前sTg>10 ng/mL（OR = 46.968，95%CI 9.731 - 226.699，P < 0.001）是预测RAT失败的独立危险因素。预后分析纳入了215例患者，在最后一次随访时6.1%（13/215）被归类为持续/复发疾病。消融前sTg>10 ng/mL（HR = 4.765，95%CI 1.371 - 16.566，P = 0.014）和FRAT（HR = 10.104，95%CI 1.071 - 95.304，P = 0.043）均独立预测持续/复发疾病。
RA很容易成功实现，而RAT评估在预后预测方面比RA具有更大的价值。对于Tg水平低且无疾病影像学证据的患者，随访期间常规的Dx-WBS意义不大。
