Kim Hye In, Kim Boram, Hyeon Jiyeon, Ko Nak Gyeong, Jin Mihyeon, Cho Jung Hwan, Han Ji Min, Suh Sunghwan, Bae Ji Cheol, Chung Man Ki, Choe Jun-Ho, Kim Sun Wook, Chung Jae Hoon, Oh Young Lyun, Kim Kyunga, Kim Tae Hyuk, Choi Joon Young
Department of Medicine, Division of Endocrinology and Metabolism, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon.
Department of Medicine, Division of Endocrinology & Metabolism, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Clin Nucl Med. 2025 Sep 1;50(9):830-839. doi: 10.1097/RLU.0000000000005940. Epub 2025 May 9.
Radioactive iodine therapy (RAI) ≥100 mCi (3.7 GBq) is commonly recommended for papillary thyroid cancer (PTC) patients with extranodal extension (ENE). However, no study has evaluated whether RAI ≥100 mCi is effective in reducing the recurrence of PTC with ENE.
This retrospective cohort study enrolled 191 PTC patients with ENE who underwent total thyroidectomy and RAI. Recurrence according to RAI activity (<100 vs. ≥100 mCi) was compared before and after propensity score matching (PSM) (1:2) using Kaplan-Meier curves and Cox proportional hazards regression models. Subgroup analyses according to mass size (<4 and ≥4 cm), gender, blood vessel invasion, lymph node (LN) number (≤5 and >5), and stimulated Tg (sTg) level (<10 and ≥10 ng/mL) before and after PSM were performed.
During about 116 months, 5 (12.5%) and 19 (12.6%) before PSM, five (12.5%) and 3 (3.8%) after PSM recorded recurrence in <100 and ≥100 mCi groups, respectively. The impact of RAI ≥100 mCi on reducing recurrence was not significant before [log-rank P = 0.915, adjusted hazard ratio (HR) 0.49 (0.12-1.85); P = 0.294) and after PSM (log-rank P = 0.077). Subgroup analysis after PSM demonstrated the impact of RAI ≥100 mCi on lowering recurrence only in ENE patients with mass size ≥4 cm (log-rank P = 0.008), LN >5 (log-rank P = 0.007), and sTg ≥10 ng/mL (log-rank P = 0.039).
In PTC patients with ENE, mass size ≥4 cm, LN >5, or sTg ≥10 ng/mL had a benefit from RAI ≥100 mCi compared with RAI <100 mCi.
对于伴有淋巴结外侵犯（ENE）的甲状腺乳头状癌（PTC）患者，通常建议放射性碘治疗（RAI）剂量≥100 mCi（3.7 GBq）。然而，尚无研究评估RAI≥100 mCi在降低伴有ENE的PTC复发方面是否有效。
这项回顾性队列研究纳入了191例接受全甲状腺切除术和RAI治疗的伴有ENE的PTC患者。使用Kaplan-Meier曲线和Cox比例风险回归模型，在倾向评分匹配（PSM）（1:2）前后比较根据RAI活性（<100与≥100 mCi）的复发情况。在PSM前后，根据肿块大小（<4和≥4 cm）、性别、血管侵犯、淋巴结（LN）数量（≤5和>5）以及刺激Tg（sTg）水平（<10和≥10 ng/mL）进行亚组分析。
在约116个月期间，PSM前<100 mCi组和≥100 mCi组分别有5例（12.5%）和19例（12.6%）复发，PSM后分别有5例（12.5%）和3例（3.8%）复发。PSM前[对数秩检验P = 0.915，调整后风险比（HR）0.49（0.12 - 1.85）；P = 0.294]和PSM后（对数秩检验P = 0.077），RAI≥100 mCi对降低复发的影响均不显著。PSM后的亚组分析表明，仅在肿块大小≥4 cm（对数秩检验P = 0.008）、LN>5（对数秩检验P = 0.007）和sTg≥10 ng/mL（对数秩检验P = 0.039）的伴有ENE的患者中，RAI≥100 mCi对降低复发有影响。
在伴有ENE的PTC患者中，与RAI<100 mCi相比，肿块大小≥4 cm、LN>5或sTg≥10 ng/mL的患者从RAI≥100 mCi中获益。
