Wang Lei, Li Yangdingxin, Yang Jing, Shen Wei, Liu Zhao, Zhu Hui, Zhang Qinghua, Hou Xiancun, Li Zhiyong, Zhu Yuan
Department of Nuclear Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Endocrine. 2025 Jul 5. doi: 10.1007/s12020-025-04316-6.
This study aimed to evaluate the prognostic significance of tumor deposits (TD) in patients with differentiated thyroid cancer (DTC) undergoing postoperative radioiodine (RAI) therapy. Additionally, it explored the potential role of TD in refining the TNM staging system.
A retrospective analysis was performed on 11,278 thyroid cancer patients who underwent surgery. After applying stringent inclusion and exclusion criteria, 2162 patients were included in the final analysis. The association between TD and various clinicopathological characteristics was assessed. Propensity Score Matching (PSM) was employed to minimize selection bias, comparing outcomes between TD-positive [TD(+)] and TD-negative [TD(-)] groups. Kaplan-Meier survival analysis was utilized to estimate cumulative incidence rate of excellent response (ER) to RAI therapy. Prognostic comparisons were conducted by stratifying patients based on TD and lymph node (LN) status. Furthermore, a novel staging system incorporating TD status into the N stage of the TNM system was developed, and its prognostic accuracy was evaluated.
Out of the 11,278 patients, 235 (2.08%) were identified as TD(+). In the 2162 patients analyzed, TD was significantly associated with T stage, N stage, extrathyroidal invasion, cumulative RAI dose, preablative stimulated thyroglobulin (Ps-Tg) levels, lymph node metastasis (LNM) count, primary tumor multiplicity, and maximum tumor diameter. Using a (1:2) PSM strategy, 95 TD(+) patients were matched with 185 TD(-) counterparts. Kaplan-Meier analysis revealed a significant difference in treatment outcomes between TD(+) and TD(-) groups (40.0% vs. 62.7%, P = 0.001). When comparing LN(+)TD(-) and LN(-)TD(+), no significant difference in outcomes was observed (59.8% vs. 44.4%, P = 0.235). However, outcomes differed significantly between LN(+)TD(+) and LN(+)TD(-) groups (39.5% vs. 59.8%, P = 0.004). No significant difference was noted between LN(+)TD(+) and LN(-)TD(+) groups (39.5% vs. 44.4%, P = 0.974). In N0 and N1a stages, TD(+) patients had significantly poorer prognoses compared to TD(-) patients (44.4% vs. 93.8%, P = 0.029 and 42.4% vs. 77.6%, P < 0.001, respectively). However, in the N1b stage, there was no significant difference between TD(+) and TD(-) groups (37.3% vs. 48.0%, P = 0.229). Interestingly, TD(+) patients in N0 and N1a stages exhibited outcomes comparable to N1b stage patients (44.4% vs. 44.5%, P = 0.603 and 42.4% vs. 44.5%, P = 0.108, respectively).
The presence of TD significantly affected the prognosis of DTC patients undergoing postoperative RAI therapy and should be considered an essential factor in assessing patient prognosis. Incorporating TD status into the TNM staging system is recommended, with TD(+) patients proposed to be classified under the N1b stage.
本研究旨在评估肿瘤沉积物（TD）在接受术后放射性碘（RAI）治疗的分化型甲状腺癌（DTC）患者中的预后意义。此外，还探讨了TD在完善TNM分期系统中的潜在作用。
对11278例接受手术的甲状腺癌患者进行回顾性分析。在应用严格的纳入和排除标准后，最终分析纳入2162例患者。评估TD与各种临床病理特征之间的关联。采用倾向评分匹配（PSM）以尽量减少选择偏倚，比较TD阳性[TD(+)]组和TD阴性[TD(-)]组的结局。利用Kaplan-Meier生存分析来估计RAI治疗的优秀反应（ER）累积发生率。根据TD和淋巴结（LN）状态对患者进行分层，进行预后比较。此外，开发了一种将TD状态纳入TNM系统N分期的新分期系统，并评估其预后准确性。
在11278例患者中，235例（2.08%）被确定为TD(+)。在分析的2162例患者中，TD与T分期、N分期、甲状腺外侵犯、累积RAI剂量、消融前刺激甲状腺球蛋白（Ps-Tg）水平、淋巴结转移（LNM）计数、原发肿瘤多灶性和最大肿瘤直径显著相关。采用（1:2）PSM策略，95例TD(+)患者与185例TD(-)患者匹配。Kaplan-Meier分析显示TD(+)组和TD(-)组的治疗结局存在显著差异（40.0%对62.7%，P = 0.001）。比较LN(+)TD(-)和LN(-)TD(+)时，未观察到结局有显著差异（59.8%对44.4%，P = 0.235）。然而，LN(+)TD(+)组和LN(+)TD(-)组的结局存在显著差异（39.5%对59.8%，P = 0.004）。LN(+)TD(+)组和LN(-)TD(+)组之间未观察到显著差异（39.5%对44.4%，P = 0.974）。在N0和N1a期，TD(+)患者的预后明显比TD(-)患者差（分别为44.4%对93.8%，P = 0.029和42.4%对77.6%，P < 0.001）。然而，在N1b期，TD(+)组和TD(-)组之间无显著差异（37.3%对48.0%，P = 0.229）。有趣的是，N0和N1a期的TD(+)患者的结局与N1b期患者相当（分别为44.4%对44.5%，P = 0.603和42.4%对44.5%，P = 0.108）。
TD的存在显著影响接受术后RAI治疗的DTC患者的预后，应被视为评估患者预后的重要因素。建议将TD状态纳入TNM分期系统，建议将TD(+)患者归类于N1b期。
