Piticchio Tommaso, Galeano Francesco, Volpe Salvatore, Prinzi Antonio, Barca Ignazio, Scuto Andrea, Le Moli Rosario, Geraci Giulio, Tumminia Andrea, Wolde Sellasie Sium, Pallotti Francesco, Frasca Francesco
Department of Medicine and Surgery, University Kore of Enna, Enna, Italy.
Department of Clinical and Experimental Medicine, Endocrinology Section, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy.
Clin Endocrinol (Oxf). 2026 Feb 23. doi: 10.1111/cen.70113.
Differentiated thyroid carcinoma (DTC) has an excellent prognosis, but recurrence remains a clinical concern, especially in intermediate-risk patients. Current stratification systems focus primarily on tumor characteristics, overlooking the host's biological capacity to counteract tumor progression. To investigate this aspect, we assessed systemic inflammatory and nutritional status using hematological indices. The study aimed to evaluate the prognostic value of these markers in predicting recurrence risk in patients with intermediate-risk DTC.
We retrospectively analyzed consecutive patients with intermediate-risk DTC who met the following criteria: (1) were classified as intermediate risk according to ATA guidelines; (2) showed an excellent or indeterminate response 12 months after initial treatment; and (3) had at least three consecutive years of follow-up at our center after thyroidectomy. Nine hematological indices were calculated from blood samples collected on the day of RAI administration. Statistical analyses included ROC curve analysis, logistic regression, and Kaplan-Meier analysis.
A total of 282 patients were included, with a median follow-up of 91 months. Among the indices tested, the monocyte-to-lymphocyte ratio (MLR) predicted recurrence better than the others. A cut-off of 0.188 yielded 82.9% sensitivity and 54.7% specificity (AUC: 0.70). In multivariate analysis, high MLR (OR = 4.94, p < 0.001), tumor size, vascular invasion, and lymph node metastases were independently associated with recurrence. Cox regression confirmed MLR as an independent predictor of shorter recurrence-free survival (HR = 3.01, p < 0.001). Nutritional indices showed no prognostic value.
Pre-RAI MLR may serve as a simple marker to refine recurrence risk stratification and personalize follow-up in intermediate-risk DTC.
分化型甲状腺癌（DTC）预后良好，但复发仍是临床关注的问题，尤其是在中危患者中。目前的分层系统主要关注肿瘤特征，而忽视了宿主对抗肿瘤进展的生物学能力。为了研究这一方面，我们使用血液学指标评估全身炎症和营养状况。本研究旨在评估这些标志物在预测中危DTC患者复发风险方面的预后价值。
我们回顾性分析了连续的中危DTC患者，这些患者符合以下标准：（1）根据ATA指南被分类为中危；（2）初始治疗12个月后显示出良好或不确定的反应；（3）甲状腺切除术后在我们中心至少连续随访三年。从放射性碘（RAI）给药当天采集的血样中计算九个血液学指标。统计分析包括ROC曲线分析、逻辑回归和Kaplan-Meier分析。
共纳入282例患者，中位随访时间为91个月。在所测试的指标中，单核细胞与淋巴细胞比值（MLR）对复发的预测优于其他指标。截断值为0.188时，敏感性为82.9%，特异性为54.7%（AUC：0.70）。在多变量分析中，高MLR（OR = 4.94，p < 0.001）、肿瘤大小、血管侵犯和淋巴结转移与复发独立相关。Cox回归证实MLR是无复发生存期较短的独立预测因素（HR = 3.01，p < 0.001）。营养指标无预后价值。
RAI治疗前的MLR可作为一个简单的标志物，用于完善中危DTC患者的复发风险分层并实现随访的个体化。
