Dou Jianping, Han Zhiyu, Che Ying, Ren Jie, Wang Shurong, Yu Songyuan, Zheng Lin, Liang Ping
Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, 100853, Beijing, China.
The First Affiliated Hospital of Dalian Medical University, 193 Lianhe Road, Xigang District, 116024, Dalian, China.
Eur Radiol. 2025 Jul 19. doi: 10.1007/s00330-025-11823-7.
Therapeutic management of radioactive iodine-refractory lymph node metastasis (RAIR-LNM) in differentiated thyroid cancer remains challenging. Thermal ablation for RAIR-LNM has gained a paucity of evidence for clinical guidelines.
This multicenter retrospective study analyzed 88 patients with 182 RAIR-LNM at 5 Chinese hospitals between June 2011 and July 2022, to evaluate the effectiveness of thermal ablation for RAIR-LNM. All included patients had at least one ≤ 3 cm RAIR-LNM. The main outcomes were the technical success and disease progression rate. Secondary outcomes included volume reduction rate (VRR), tumor disappearance ratio and the complication rate. Subgroup analyses were performed by using Kaplan-Meier curves and Cox proportional hazards regression models.
The mean diameter was 1.35 ± 0.65 cm. The technical success rate was 100% and all elevated thyroglobulin (Tg) levels returned to normal after ablation. Over a mean follow-up period of 55.3 ± 31.39 months, disease progression occurred in 18.18% of patients (16 of 88). Subgroup analysis revealed significantly reduced rates of disease progression (p < 0.05) and new LNM development in patients with Tg ≤ 35 μg/L. Multivariable analysis identified Tg level as a predictor associated with new LNM and disease progression, whereas tumor size and ablation modality showed no statistically significant associations. LNM shrank evidently after ablation, and the disappearance rate was higher for LNM ≤ 1 cm. The overall complication rate was 10.23% (9 of 88).
Thermal ablation emerges as a viable therapeutic strategy for RAIR-LNM, offering durable local tumor control and prolonged progression-free survival, especially for patients with Tg < 35 μg/L.
Question Whether thermal ablation for radioactive iodine refractory lymph node metastasis could achieve a long-term survival benefit. Findings Reduced rates of disease progression and new lymph node metastasis development were found in patients with thyroglobulin ≤ 35 μg/L. Clinical relevance Thermal ablation serves as a viable therapeutic strategy for patients with radioactive iodine-refractory lymph node metastasis. It offers durable local tumor control and prolonged progression-free survival, especially for patients with lower thyroglobulin levels.
分化型甲状腺癌放射性碘难治性淋巴结转移（RAIR-LNM）的治疗管理仍然具有挑战性。热消融治疗RAIR-LNM在临床指南中缺乏证据支持。
这项多中心回顾性研究分析了2011年6月至2022年7月期间中国5家医院的88例患者的182处RAIR-LNM，以评估热消融治疗RAIR-LNM的有效性。所有纳入患者均至少有一处直径≤3 cm的RAIR-LNM。主要结局为技术成功率和疾病进展率。次要结局包括体积缩小率（VRR）、肿瘤消失率和并发症发生率。采用Kaplan-Meier曲线和Cox比例风险回归模型进行亚组分析。
平均直径为1.35±0.65 cm。技术成功率为100%，消融后所有升高的甲状腺球蛋白（Tg）水平均恢复正常。在平均55.3±31.39个月的随访期内，18.18%的患者（88例中的16例）出现疾病进展。亚组分析显示，Tg≤35μg/L的患者疾病进展率（p<0.05）和新的淋巴结转移发生率显著降低。多变量分析确定Tg水平是与新的淋巴结转移和疾病进展相关的预测因素，而肿瘤大小和消融方式无统计学显著关联。消融后淋巴结明显缩小，直径≤1 cm的淋巴结消失率更高。总体并发症发生率为10.23%（88例中的9例）。
热消融是RAIR-LNM的一种可行治疗策略，可实现持久的局部肿瘤控制并延长无进展生存期，尤其是对于Tg<35μg/L的患者。
问题放射性碘难治性淋巴结转移的热消融能否实现长期生存获益。发现甲状腺球蛋白≤35μg/L的患者疾病进展率和新的淋巴结转移发生率降低。临床意义热消融是放射性碘难治性淋巴结转移患者的一种可行治疗策略。它可实现持久的局部肿瘤控制并延长无进展生存期，尤其是对于甲状腺球蛋白水平较低的患者。
