文章：

不同分化型甲状腺癌患者中，血清甲状腺球蛋白升高但无结构性病变证据时，经验性放射性碘治疗的疗效：一项倾向性评分分析

Efficacy of Empirical Radioiodine Therapy in Patients with Differentiated Thyroid Cancer and Elevated Serum Thyroglobulin without Evidence of Structural Disease: A Propensity Score Analysis

原文发布日期：21 August 2023

DOI: 10.3390/cancers15164196

类型: Article

开放获取: 是

英文摘要：

We assessed the outcome of administration of empiric radioactive iodine (RAI) therapy to patients with differentiated thyroid cancer (DTC), in a propensity-score-matched cohort of patients with biochemical incomplete response (BIR) and without evidence of structural disease. We retrospectively evaluated 820 DTC patients without distant metastases, who underwent total thyroidectomy followed by RAI therapy, with available BIR at 12 months and follow-up evaluations. The patients were categorized according to the administration of empiric therapy (ET). To account for differences between patients with (n= 119) and without (n= 701) ET, a propensity-score-matched cohort of 119 ET and 119 no-ET patients was created. The need for additional therapy and the occurrence of structural disease were considered as end-points. During a median follow-up of 53 months (range 3–285), 57 events occurred (24% cumulative event rate). The rate of events was significantly higher in the no-ET compared to the ET patients (30% vs. 18%p< 0.001). The multivariate Cox analysis identified age (p< 0.01), pre-therapy Tg (p< 0.05) and empiric RAI therapy (p< 0.01) as predictors of outcome. The Kaplan–Meier analysis found that progression-free survival was lower in no-ET patients compared to the ET group (p< 0.01). In patients with DTC treated with surgery and RAI, and with biochemical incomplete response at the 12-month evaluation, their prognosis seemed to be affected by Tg values and the empiric treatment. The identification of candidates for this approach may improve prognosis.

摘要翻译： 

本研究通过倾向性评分匹配，评估了经验性放射性碘治疗对生化不完全缓解且无结构性病变证据的分化型甲状腺癌患者的疗效。我们回顾性分析了820例无远处转移的DTC患者，这些患者均接受全甲状腺切除术后行RAI治疗，并在12个月时存在生化不完全缓解且具有随访评估数据。根据是否接受经验性治疗将患者分组。为平衡接受ET组（n=119）与未接受ET组（n=701）间的差异，构建了119对倾向性评分匹配队列。研究终点设定为是否需要追加治疗及结构性病变的发生。在中位53个月（范围3-285个月）的随访期间，共发生57起终点事件（累计事件率24%）。未接受ET组的事件发生率显著高于ET组（30% vs. 18%，p<0.001）。多变量Cox分析显示年龄（p<0.01）、治疗前Tg水平（p<0.05）及经验性RAI治疗（p<0.01）是预后的独立预测因子。Kaplan-Meier分析表明未接受ET组患者的无进展生存期显著低于ET组（p<0.01）。对于接受手术及RAI治疗且在12个月评估时存在生化不完全缓解的DTC患者，其预后似乎受Tg值及经验性治疗影响。精准筛选适合该治疗策略的患者可能改善预后。

原文链接：

Efficacy of Empirical Radioiodine Therapy in Patients with Differentiated Thyroid Cancer and Elevated Serum Thyroglobulin without Evidence of Structural Disease: A Propensity Score Analysis