Cao Jingjia, Li Xiang, Liang Huazhen, Li Yang, Zhao Fei, Dong Aiqiang
Department of Nuclear Medicine, The Second Hospital of Shandong University, Jinan, 250033, China.
Department of Second Clinical Medical School, Shandong University, Jinan, 250012, China.
Ann Nucl Med. 2025 Jun;39(6):535-545. doi: 10.1007/s12149-025-02029-4. Epub 2025 Feb 20.
Compared with those of sporadic differentiated thyroid cancer (SDTC), the tumor characteristics of familial nonmedullary thyroid cancer (FNMTC) remain debatable. In addition, there is a paucity of data suggesting that their response to radioactive iodine (RAI) therapy differs from that of SDTC. We aimed to determine whether FNMTC is a homogenous biological entity that differs from SDTC in RAI therapy.
We retrospectively analyzed patients who underwent adjuvant ablative iodine radiotherapy between July 2016 and March 2020. We compared the differences in clinicopathological features and prognoses between the FNMTC and SDTC groups. The endpoint of the study was the rate of therapeutic response after 1 and 3 years of follow-up after first-line treatment. The response to therapy was classified into four categories: excellent response (ER), biochemical incomplete response (BIR), structural incomplete response (SIR) and indeterminate response (IDR). In addition, we conducted a meta-analysis of cohort studies to investigate the clinical outcomes.
Of all the patients (n = 1758), 109 (6.2%) were classified as having FNMTC, whereas the remaining 1649 (93.8%) had SDTC. A greater proportion of FNMTC patients presented with extrathyroidal extension, capsular invasion, and multifocality (P = 0.01). In addition, patients with FNMTC were more likely to have advanced primary tumor stage and lymph node metastasis, but the differences were not statistically significant. At the end of follow-up (median follow-up of 3 years), the response to RAI therapy was significantly different between the two groups (ER: 66.1% vs 74.3%; IDR: 9.2% vs 12.1%; SIR: 14.7% vs 7.1%; BIR: 10.1% vs 6.5%). Moreover, patients with FNMTC more frequently presented evidence of disease than patients with SDTC did. However, the disease-free survival of patients with FNMTC was not shorter than that of patients with SDTC (P ≥ 0.05).
Patients with FNMTC more often have aggressive characteristics at presentation and relatively worse clinical outcomes after RAI therapy. However, there was no statistically significant difference in the recurrence rate in the short-term follow-up. Considering that, FNMTC patients may be required more aggressive treatment approaches and closer postoperative monitoring.
与散发性分化型甲状腺癌（SDTC）相比，家族性非髓样甲状腺癌（FNMTC）的肿瘤特征仍存在争议。此外，鲜有数据表明其对放射性碘（RAI）治疗的反应与SDTC不同。我们旨在确定FNMTC是否为一种在RAI治疗方面与SDTC不同的同质生物学实体。
我们回顾性分析了2016年7月至2020年3月期间接受辅助性消融碘放疗的患者。我们比较了FNMTC组和SDTC组在临床病理特征和预后方面的差异。研究终点为一线治疗后1年和3年随访时的治疗反应率。治疗反应分为四类：优秀反应（ER）、生化不完全反应（BIR）、结构不完全反应（SIR）和不确定反应（IDR）。此外，我们对队列研究进行了荟萃分析以调查临床结局。
在所有患者（n = 1758）中，109例（6.2%）被归类为患有FNMTC，其余1649例（93.8%）患有SDTC。FNMTC患者中甲状腺外侵犯、包膜侵犯和多灶性的比例更高（P = 0.01）。此外，FNMTC患者更有可能处于原发性肿瘤晚期和发生淋巴结转移，但差异无统计学意义。在随访结束时（中位随访3年），两组对RAI治疗的反应存在显著差异（ER：66.1%对74.3%；IDR：9.2%对12.1%；SIR：14.7%对7.1%；BIR：10.1%对6.5%）。此外，FNMTC患者出现疾病证据的频率高于SDTC患者。然而，FNMTC患者的无病生存期并不短于SDTC患者（P≥0.05）。
FNMTC患者在初诊时往往具有侵袭性特征，且RAI治疗后的临床结局相对较差。然而，短期随访中的复发率无统计学显著差异。考虑到这一点，FNMTC患者可能需要更积极的治疗方法和更密切的术后监测。
