Response to Therapy Assessment in Intermediate-Risk Thyroid Cancer Patients: Is Thyroglobulin Stimulation Required?

Is Stimulated Thyroglobulin Before Radioiodine Therapy a Useful Tool in Predicting Response to Initial Therapy in Patients with Differentiated Thyroid Carcinoma?

Thyroglobulin (Tg) is an important tool to evaluate the persistence and recurrence risk in differentiated thyroid cancer (DTC). We aimed to evaluate the correlation between pre-radioiodine therapy stimulated Tg (pre-RAI Tg) levels and the first response to treatment evaluation, and to establish a cut-off pre-RAI Tg threshold for predicting an initial excellent response. Retrospective cohort study of DTC patients who underwent total thyroidectomy and radioiodine therapy. Response to therapy was evaluated 6 to 24 months after initial therapy, and patients were classified as: excellent response (ER); indeterminate response (IndR) and incomplete response (IncR). Total patients: 166 among which 85.5% female with mean age of 47.6 ± 13 years. The ER had a significantly lower pre-RAI Tg in comparison to IndR (p<0.001) and IncR (p<0.001), and pre-RAI Tg were different between the IndR and IncR (p=0.02). A cut-off pre-RAI Tg value at 7.55ng/ml was obtained by receiver operating characteristics curve for differentiating ER from IndR and IncR. The area under curve was 0.832 (95% CI 0.76-0.91). In multivariate analysis, ATA low-risk (RR 1.61, 95% CI 1.06-2.43, p=0.025) and Tg below 7.55ng/ml (RR 2.17, 95% CI 1.52-3.10, p<0.001) were associated with ER. After a median of 7.4-year follow-up, 124 (74.7%) patients were allocated into ER, 22 (13.2%) into IndR, and 20 (12%) into IncR. In conclusion, pre-RAI Tg predicts first evaluation of treatment response. Pre-RAI Tg cut-off was a key predictor of initial excellent response to therapy and may be an important tool in the follow-up of DTC patients.

Comparison of Prognostic Value Between Stimulated and Nonstimulated Thyroglobulins in Differentiated Thyroid Cancer: A Retrospective Study

Purpose

The growing incidence of differentiated thyroid cancer (DTC) demands dependable prognostic factors to guide follow-up and treatment plans. This study investigated the prognostic value of response to therapy (RTT) assessment using TSH stimulated-thyroglobulin (sti-Tg) and nonstimulated-thyroglobulin (nonsti-Tg) and evaluates whether RTT using nonsti-Tg (nonstiRTT) can replace RTT using sti-Tg (stiRTT) in clinical practice to improve patients' quality of life during assessment.

Methods

We enrolled 419 DTC patients who underwent total thyroidectomy, radioactive iodine (RAI) therapy, and Tg assessment. Patients with structural incomplete responses were excluded. Initial RTT assessments based on the 2015 American Thyroid Association guidelines (excellent response; ER, indeterminate response, biochemical incomplete response) were performed 6-24 months after RAI therapy. The second RTT assessments were performed 6-24 months after the first assessment. Statistical analysis for recurrence-free survival (RFS) was done with the log-rank test for stiRTT and nonstiRTT.

Results

Although initial stiRTT and nonstiRTT were significant predictors for RFS (p < 0.0001), stiRTT provided better RFS prediction than nonstiRTT. The RFS analysis of the second RTT assessment demonstrated statistical significance only for stiRTT (p < 0.0001). In 116 patients classified as ER on initial stiRTT, there was no RFS difference between patients classified as ER on either second stiRTT or nonstiRTT.

Conclusion

The prognostic power of stiRTT surpasses that of nonstiRTT in both the initial and second RTT assessment. Nevertheless, among patients classified as ER on initial stiRTT, a second stiRTT may not be required for those classified as ER on the second nonstiRTT.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13139-023-00811-8.

CENPF promotes papillary thyroid cancer progression by mediating cell proliferation and apoptosis

Papillary thyroid cancer (PTHCA) accounts for ~85% cases of thyroid cancer and exhibits high incidence. Targeted therapy is an effective method to combat this disease; however, novel therapeutic targets are required. Centromere protein F (CENPF), a member of centromere proteins and a transient kinetochore protein, regulates various cellular processes such as cell migration and mitosis, and its upregulation has been observed in multiple types of cancer, including breast cancer and gastric cancer. However, the potential role of CENPF in PTHCA progression is remains unclear. The results of the current study demonstrated that CENPF expression was enhanced in human PTHCA tissues through IHC assays. Furthermore, the expression of CENPF was correlated with the prognosis and the clinicopathological features, including T stage (P=0.021) and intraglandular dissemination (P=0.042) in patients with PTHCA. CENPF regulated the proliferation, apoptosis and cell cycle of PTHCA cells in vitro, which was confirmed through colony formation, MTT and flow cytometry assays, and affected tumor growth in vivo in mice. In conclusion, the current study reported the involvement of CENPF in PTHCA progression and provided a promising therapeutic target for PTHCA treatment.

Preoperative Use of Intravenous Contrast Media Is Associated With Decreased Excellent Response Rates in Intermediate-Risk DTC Patients Who Subsequently Receive Total Thyroidectomy and Low-Dose RAI Therapy

Purpose: To evaluate the impact of preoperative use of intravenous contrast media (ICM) on the excellent response (ER) rates in a cohort of intermediate-risk differentiated thyroid cancer (DTC) patients who received total thyroidectomy (TT) and low-dose radioactive iodine (RAI) therapy.

Methods: A total of 683 consecutive patients were retrospectively reviewed in a single center between August 2016 and August 2018. Patients were divided into ICM group (n = 532) and non-ICM group (n = 151). Intravenous contrast media patients were 1:1 propensity matched to non-ICM patients based on T stage, N stage, and urinary iodine. Risk-adjusted logistic regression models were constructed to assess the association between the use of ICM and ER rates.

Results: Intravenous contrast media patients had significantly higher T stage (P < 0.001), N stage (P < 0.001), urinary iodine (P < 0.001), and ps-Tg (P = 0.042) than non-ICM patients. Preoperative use of ICM was found to be significantly associated with decreased ER rates in both the primary cohort [odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.32–0.71; P < 0.001] and the matched cohort (OR = 0.48, 95% CI = 0.25–0.94; P = 0.031). Subgroup analysis on RAI delay time in the primary cohort revealed that ER rates in ICM patients were significantly lower than that of non-ICM patients for 1–2 months (P = 0.0245) and >2–3 months (P = 0.0221) subgroups, but not for >3–4 months, >4–5 months, and >5–6 months subgroups (all P > 0.05). A delay time of >3–4 months exhibited the highest ER rate (63.08%) within the ICM group.

Conclusions: Preoperative use of ICM is associated with decreased ER rates in intermediate-risk DTC patients who subsequently receive TT and low-dose RAI therapy. For such patients, if ICM has already been received, an RAI delay time of >3–4 months would seem to be more appropriate to achieve better ER rates.