Unfavorable Responses to Radioiodine Therapy in N1b Papillary Thyroid Cancer: A Propensity Score Matching Study |
| |
| Institution: | 1. From the Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing, China;2. Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China;3. Department of Oncology, the Affiliated Hospital of Qingdao University, Qingdao, China.;1. From George Washington University, Biostatistics Center, Rockville, Maryland;2. University of California San Diego, La Jolla, California;3. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland;4. National Institute on Deafness and Other Communication Disorders, Bethesda, Maryland;5. University of Wisconsin-Madison, Madison, Wisconsin;6. University of Iowa, Iowa City, Iowa;7. Case Western Reserve University, Cleveland, Ohio;8. Massachusetts General Hospital, Boston, Massachusetts;9. University of Toronto, Toronto, Ontario, Canada;10. University of New Mexico, Albuquerque, New Mexico.;1. From the Division of Endocrinology, University of Utah, Salt Lake City, Utah;2. Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania;3. Tri Health, Cincinnati, Ohio;4. Division of Ear, Nose, & Throat, University of Utah, Salt Lake City, Utah;5. the Department of Pathology, University of Utah, Salt Lake City, Utah.;1. Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China.;2. Department of Pathology, Tianjin Medical University General Hospital, Tianjin, China.;1. From the Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy;2. IRCCS Orthopedic Institute Galeazzi, Endocrinology Service, Milan, Italy;3. Medical Physics Department, Santa Croce and Carle Hospital, Cuneo, Italy.;1. From the Divsion of Endocrinology and Metabolism, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia;2. Division of Internal Medicine, Grady Memorial Hospital, Atlanta, Georgia;3. Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Chicago, Chicago, Illinois;4. Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia;5. Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia;6. Division of General Internal Medicine, Palliative Medicine, and Medical Education, Department of Medicine, University of Louisville, Louisville, Kentucky;7. Division of General Internal Medicine and Hypertension, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi. |
| |
| Abstract: | Objective: Regional nodal metastases carry prognostic significance in papillary thyroid cancer (PTC). However, whether different locational nodal metastases correlate with different therapeutic responses remains controversial. We innovatively applied the response to therapy restratification system to evaluate the dynamic disease status after surgery and radioactive iodine (RAI) therapy in PTC patients with different locational nodal metastases.Methods: A total of 585 nondistant-metastatic PTC patients who underwent total thyroidectomy and RAI therapy were retrospectively enrolled. Patients with nodal metastases were categorized into N1a and N1b groups. Propensity score matching was used to balance the bias between the 2 groups. Therapeutic responses were dynamically evaluated, and responses to RAI therapy were classified into excellent (ER), indeterminate (IDR), biochemical incomplete (BIR) and structural incomplete response (SIR).Results: N1b group patients showed a significantly higher pre-ablation stimulated thyroglobulin (Ps-Tg) level than N1a group patients (7.4 ng/mL versus 3.2ng/mL, P<.001). After RAI therapy, N1b group patients took a longer time to achieve ER (9.86 months versus 3.29 months, P<.001) and exhibited a higher proportion of non-ER (IDR, BIR, and SIR) (39.15% versus 17.46%, P<.001) compared to N1a group patients. In logistic regression, N1b and Ps-Tg ≥10 ng/mL were confirmed to be independent factors predicting non-ER (odds ratio: 2.591, and 9.196, respectively). In Cox regression, patients with N1b disease and Ps-Tg ≥10 ng/mL showed significantly lower hazards for achieving ER (hazard ratio: 0.564, and 0.223, respectively).Conclusion: N1b PTC patients showed inferior responses to surgery and RAI therapy compared to N1a patients. N1b was confirmed to be an independent factor predicting unfavorable responses to RAI therapy.Abbreviations: AJCC = American Joint Committee on Cancer; ATA = American Thyroid Association; BIR = biochemical incomplete response; BRAFV600E = proto-oncogene B-Raf V600E mutation; CI = confidence interval; CT = computed tomography; DNA = deoxyribonucleic acid; DTC = differentiated thyroid cancer; ER = excellent response; ETE = extrathyroidal extension; HR = hazard ratio; IDR = indeterminate response; LNM = lymph node metastasis; N1a = central cervical LNM; N1b = lateral cervical LNM; OR = odds ratio; PSM = propensity score matching; Ps-Tg = pre-ablation stimulated thyroglobulin; PTC = papillary thyroid cancer; RAI = radioactive iodine; SIR = structural incomplete response; Tg = thyroglobulin; TgAb = thyroglobulin antibody; TSH = thyroid-stimulating hormone |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
