Ora Manish, Nazar Aftab Hasan, Mishra Prabhakar, Barai Sukanta, Arya Amitabh, Pradhan Prasanta Kumar, Gambhir Sanjay
Departments of Nuclear Medicine.
Biostatistics and Health Informatics, SGPGIMS, Lucknow, Uttar Pradesh, India.
Nucl Med Commun. 2025 Jan 1;46(1):21-27. doi: 10.1097/MNM.0000000000001923. Epub 2024 Nov 7.
Differentiated thyroid carcinoma (DTC) is managed by surgery followed by radioiodine (RAI) therapy in most intermediate and high-risk patients. Most nonmetastatic patients have excellent treatment responses and have long-term disease-free status. A lack of comprehensive medical services in resource-limited nation leads to attrition of critical clinical prognostication information. This study aimed to identify readily available clinical, biochemical, and histopathological parameters to predict remnant ablation success and long-term outcomes.
The study included DTC patients who underwent RAI after surgery. Ablation success was determined by thyroglobulin (Tg) and whole-body radioiodine scan. Patients were followed for at least 5 years to assess biochemical incomplete response (BIR) and structural recurrence.
The study included 383 patients (a mean age of 37.8 ± 12.9 years). Successful ablation was noted in 251 (65.5%). High preablative stimulated serum Tg (presTg), papillary variants, and central and lateral compartment lymph nodal metastases were associated with ablation failure. PresTg ( P < 0.001) was the most significant predictor. After a 102.9 ± 34.5 months follow-up, 280 (73.1%) patients were disease-free. BIR and structural recurrence were noted in 103 and 32 patients. PresTg (8.1 ± 27.7 vs. 92.3 ± 99.9 ng/ml), ATg (112.9 ± 389.8 vs. 43.2 ± 89.8 IU/ml), papillary variant, central [109 (66.1%) vs. 56 (33.9%)], and lateral compartment [65 (63.7%) vs. 37 (36.3%) lymph nodal metastases were associated ( P < 0.05) with BIR. PresTg >10.5 ng/ml has a sensitivity and specificity of 86.6 and 86.0% for predicting BIR. Patients with successful remnant ablation and a presTg level <10.5 ng/ml had a low risk of long-term disease recurrence (less than 5%).
This ambispective study found that successful ablation and long-term disease-free survival were achievable in a significant proportion of DTC patients. BIR (26.9%) and structural recurrence (8.4%) were not uncommon. PresTg levels emerged as a crucial predictor of ablation success and subsequent outcomes. In resource-limited regions, presTg levels and ablation failure can aid in optimizing treatment strategies and improving patient care.
大多数中高危分化型甲状腺癌（DTC）患者通过手术治疗，随后接受放射性碘（RAI）治疗。大多数非转移性患者治疗反应良好，长期无病生存。资源有限国家缺乏全面的医疗服务导致关键临床预后信息缺失。本研究旨在确定易于获得的临床、生化和组织病理学参数，以预测残余灶消融成功率和长期预后。
本研究纳入术后接受RAI治疗的DTC患者。通过甲状腺球蛋白（Tg）和全身放射性碘扫描确定消融成功率。对患者随访至少5年，以评估生化不完全缓解（BIR）和结构复发情况。
本研究纳入383例患者（平均年龄37.8±12.9岁）。251例（65.5%）消融成功。消融前刺激血清Tg（presTg）水平高、乳头状亚型以及中央和侧方区域淋巴结转移与消融失败相关。PresTg（P<0.001）是最显著的预测因素。经过102.9±34.5个月的随访，280例（73.1%）患者无病生存。103例和32例患者出现BIR和结构复发。PresTg（8.1±27.7 vs. 92.3±99.9 ng/ml）、抗Tg（112.9±389.8 vs. 43.2±89.8 IU/ml）、乳头状亚型、中央区域[109例（66.1%） vs. 56例（33.9%）]和侧方区域[65例（63.7%） vs. 37例（36.3%）]淋巴结转移与BIR相关（P<0.05）。PresTg>10.5 ng/ml预测BIR的敏感性和特异性分别为86.6%和86.0%。残余灶消融成功且presTg水平<10.5 ng/ml的患者长期疾病复发风险较低（低于5%）。
这项前瞻性研究发现，相当一部分DTC患者能够实现成功消融和长期无病生存。BIR（26.9%）和结构复发（8.4%）并不少见。PresTg水平是消融成功及后续预后的关键预测因素。在资源有限地区，presTg水平和消融失败情况有助于优化治疗策略并改善患者护理。
