Yao Qixian, Song Lili, Xu Jun, Wu Zhongliang
Department of Surgery, Community Health Service Center of Suzhou Science & Technology Town, Suzhou, Jiangsu, China.
Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Front Endocrinol (Lausanne). 2024 Dec 17;15:1474121. doi: 10.3389/fendo.2024.1474121. eCollection 2024.
Radioactive iodine (RAI) is commonly used in the management of differentiated thyroid cancers (DTCs). However, the long-term efficacy and the risk of tumor recurrence associated with it remain unclear. In particular, the comparison between recombinant human thyrotropin (rhTSH) and thyroid hormone withdrawal (THW) in terms of medium- and long-term recurrence rate in DTC patients has not been fully elucidated.
A systematic search was carried out to identify articles comparing medium- and long-term outcomes (> 2 years) based on treatment with either rhTSH or THW. Ten studies, consisting of six randomized controlled trials (RCTs) and four retrospective studies with a total of 2,833 patients, were included in the analysis.
There was no significant difference in the medium- and long-term recurrence rates between the rhTSH group and the THW group. This was also the case in subgroup analyses of only RCTs or only retrospective studies. The structural incomplete response (SIR) rate was slightly higher in the rhTSH group, but a subgroup analysis of RCTs alone showed no significant difference in SIR between the two groups.
rhTSH is comparable to THW in achieving successful ablation of residual disease and maintaining low recurrence rates. However, further RCTs are required to investigate whether rhTSH can increase the risk of SIR.
放射性碘（RAI）常用于分化型甲状腺癌（DTC）的治疗。然而，其长期疗效及与之相关的肿瘤复发风险仍不明确。特别是，重组人促甲状腺素（rhTSH）与甲状腺激素撤减（THW）在DTC患者中长期复发率方面的比较尚未得到充分阐明。
进行系统检索以识别比较基于rhTSH或THW治疗的中长期结局（>2年）的文章。分析纳入了10项研究，包括6项随机对照试验（RCT）和4项回顾性研究，共2833例患者。
rhTSH组和THW组的中长期复发率无显著差异。仅RCT或仅回顾性研究的亚组分析结果亦是如此。rhTSH组的结构不完全缓解（SIR）率略高，但仅RCT的亚组分析显示两组间SIR无显著差异。
在实现残留病灶的成功消融及维持低复发率方面，rhTSH与THW相当。然而，需要进一步的RCT来研究rhTSH是否会增加SIR风险。
