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Yin X, Lu C, Sun D, Ji Y, Wang Y, Zheng H, Ma Z, Jia Q, Tan J, Zheng W. Stimulating thyroglobulin to TSH ratio predict long-term efficacy of 131I therapy in patients with differentiated thyroid cancer after total thyroidectomy: a retrospective study. Endocrine 2024; 84:1064-1071. [PMID: 38172344 DOI: 10.1007/s12020-023-03663-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE This study utilized the stimulated thyroglobulin (sTg) to thyroid stimulating hormone (TSH) ratio to predict the long-term efficacy of 131I therapy in patients with moderate-to-high-risk differentiated thyroid cancer (DTC). METHODS This study retrospectively analyzed 960 DTC patients with a median follow-up time of 30 months (6-92 months). The median age was 44 years. All patients underwent total thyroidectomy, lymph node dissection, and at least one 131I therapy. Patients were subjected to a final efficacy evaluation according to American Thyroid Association's 2015 guidelines. Patients were grouped according to their TSH levels before the initial 131I therapy and the final efficacy evaluation, and factors influencing TSH levels and final efficacy were analyzed. Construction of nomograms using independent risk factors affecting long-term outcomes. The cut-offs of sTg and sTg/TSH ratios were calculated for different long-term outcomes. Progression-free survival (PFS) of patients was analyzed by making Kaplan-Meier survival according to the cut-offs of sTg and sTg/TSH ratio. RESULTS TSH (mU/L) levels were more concentrated at 60-90 in females (71.5%) and 30-60 in males (39.0%), while patients with younger age, more lymph node metastases, shorter time interval between surgery and the first 131I therapy, and lower dose of levothyroxine sodium taken prior to the first 131I therapy would have higher TSH levels (All P < 0.05).Patients who are male, have primary tumor involvement of the strap muscles, lymph node metastasis, distant metastasis, and higher sTg and sTg/TSH are more likely to have poor long-term outcomes (All P < 0.05).The cut-offs of sTg and sTg/TSH for long-term efficacy were 7.515 and 0.095. STg, sTg/TSH, tumor size, lymph node metastasis, and distant metastasis were shown to be independent risk factors for long-term efficacy. The mean PFSs were longer for patients who had sTg/TSH ≤ 0.095 and/or sTg≤7.515 ug/L. CONCLUSIONS For patients with moderate-to-high-risk DTC, when sTg>7.515 ug/L and/or sTg/TSH > 0.095 before the first 131I therapy, patients are more likely to have a poor long-term efficacy after full 131I therapy. This means that this group of patients may require further surgical treatment or targeted drug therapy after 131I therapy.
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Affiliation(s)
- Xue Yin
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Lu
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Danyang Sun
- Department of Nuclear Medicine, Tianjin Medical University General Hospital Airport Site, Tianjin, China
| | - Yanhui Ji
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yan Wang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongyuan Zheng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Ziyu Ma
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiang Jia
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Zheng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China.
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Wen R, Zhao M, Chen C, Yang Y, Zhang B. A novel nomogram integrated with preablation stimulated thyroglobulin and thyroglobulin/thyroid-stimulating hormone ratio to predict the therapeutic response of intermediate‑ and high‑risk differentiated thyroid cancer patients: a bi-center retrospective study. Endocrine 2024; 84:989-998. [PMID: 38085420 DOI: 10.1007/s12020-023-03625-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/22/2023] [Indexed: 06/27/2024]
Abstract
PURPOSE To investigate the factors influencing the outcome of radioactive iodine (RAI) treatment in intermediate- to high-risk patients with differentiated thyroid carcinoma (DTC). METHODS We enrolled 553 DTC patients who underwent total thyroidectomy and categorized them into two groups according to their response to RAI therapy: excellent response (ER) and non-ER groups. Clinical and pathological characteristics of the patients were collected and retrospectively analyzed using univariate and multivariate binary logistic regression. Receiver operating characteristic (ROC) curves and diagnostic cutoff values were analyzed to assess the predictive value of important quantitative influences on 131I treatment outcomes. A new nomogram model was developed based on the above independent risk factors. R software was used to develop nomograms with all the independent prognostic factors included. RESULTS The multivariate analysis showed that lymph node metastasis (LNM), stimulated thyroglobulin (sTg), thyroglobulin antibodies (TgAb), and sTg/thyroid-stimulating hormone (TSH) were significantly associated with non-ER of DTC patients. In the training set, the consistency index (C-index) of the new column line graph was 0.868 (95% CI 0.865-0.871). CONCLUSION We proposed a new nomogram to predict non-ER for DTC with excellent discrimination and calibration.
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Affiliation(s)
- Runze Wen
- Department of Nuclear Medicine, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Min Zhao
- Department of Nuclear Medicine, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chang Chen
- Department of Nuclear Medicine, Suzhou Science and Technology Town Hospital, Suzhou, China
| | - Yi Yang
- Department of Nuclear Medicine, Suzhou Science and Technology Town Hospital, Suzhou, China
| | - Bin Zhang
- Department of Nuclear Medicine, First Affiliated Hospital of Soochow University, Suzhou, China.
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Zhou Y, Wang Y, Zhang Z, Yin X, Liu J, Zheng W. Male Sex Is Not a Risk Factor for Prognosis in Postoperative Thyroid Cancer Patients: A Propensity Score Matching Study. J Clin Endocrinol Metab 2023; 108:3330-3337. [PMID: 37267432 DOI: 10.1210/clinem/dgad314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE To study whether male sex is a risk factor for prognosis in patients with differentiated thyroid cancer after 131I treatment using the propensity score matching (PSM) method. METHODS From April 2016 to October 2021, 1948 postoperative differentiated thyroid cancer patients aged 43 (interquartile range: 34, 54) years who received 131I treatment were retrospectively enrolled and divided into male (n = 645) and female groups (n = 1303). The PSM method was adopted to process all data to reduce the influence of data bias and confounding variables. The Mann-Whitney U test and χ2 test were used for data analysis. Multivariate logistic regression was used to analyze the risk factors affecting prognosis, and the receiver operating characteristic curve was used to analyze the relationship between stimulated thyroglobulin (sTg) level, 131I dose, and poor prognosis. RESULTS Before PSM, the proportion of male patients with poor prognosis was significantly higher than that of female patients. After PSM, there was no difference in the proportion of poor prognosis between male and female groups. Multivariate logistic regression analysis showed that male sex; high T stage, N1b stage, and M1 stage; high sTg level; and high 131I dose were risk factors for poor prognosis before PSM. After PSM, high T stage, M1 stage, high sTg level, and 131I dose were still risk factors but male sex was no longer a risk factor for poor prognosis. CONCLUSIONS After the reduction of selection bias by PSM, male sex was no longer a risk factor for prognosis after 131I treatment of differentiated thyroid cancer. In addition, high T stage (T3 + T4 stage), M1 stage, sTg ≥10.15 ng/mL, and 131I dose ≥260 mCi were risk factors for poor prognosis.
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Affiliation(s)
- Yaqian Zhou
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300041, China
- Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
| | - Yan Wang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300041, China
| | - Zhiting Zhang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300041, China
| | - Xue Yin
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300041, China
| | - Jianjun Liu
- Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
| | - Wei Zheng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300041, China
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Han N, Lu C, Li J, Wang C, Zhao Z, Zhang Y, Liu X, Si Z, Wang G, Wang Z, Li F, Wang X. Stimulated thyroglobulin and pre-ablation antithyroglobulin antibody products can predict the response to radioiodine therapy of TgAb-positive differentiated thyroid cancer patients: a retrospective study. Front Endocrinol (Lausanne) 2023; 14:1222470. [PMID: 37810895 PMCID: PMC10556735 DOI: 10.3389/fendo.2023.1222470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Objective We aimed to explore the predictive value of stimulated thyroglobulin (sTg) and pre-ablation antithyroglobulin (pa-TgAb) products for the effect of radioiodine therapy (RAIT) on TgAb-positive differentiated thyroid cancer (DTC) patients. Methods In this study, we enrolled 265 patients with TgAb-positive DTC who underwent RAIT after total thyroidectomy (TT). Based on the last follow-up result, the patients were divided into two groups: the excellent response (ER) group and the non-excellent response (NER) group. We analyzed the factors related to the effect of RAIT. Results The ER group consisted of 197 patients. The NER group consisted of 68 patients. For the univariate analysis, we found that the maximal tumor diameter, whether with extrathyroidal extension (ETE), bilateral or unilateral primary lesion, multifocality, preoperative TgAb (preop-TgAb), pa-TgAb, sTg × pa-TgAb, initial RAIT dose, N stage, and surgical extent (modified radical neck dissection or not), showed significant differences between the ER group and NER group (all p-values <0.05). The receiver operating characteristic (ROC) curves showed that the cutoff value was 724.25 IU/ml, 424.00 IU/ml, and 59.73 for preop-TgAb, pa-TgAb, and sTg × pa-TgAb, respectively. The multivariate logistic regression analysis results indicated that pa-TgAb, sTg × pa-TgAb, initial RAIT dose, and N stage were independent risk factors for NER (all p-values <0.05). For the Kaplan-Meier analysis of disease-free survival (DFS), the median DFS of the patients with sTg × pa-TgAb < 59.73 and initial RAIT dose ≤ 100 mCi was significantly longer than that of the patients with sTg × pa-TgAb ≥ 59.73 (50.27 months vs. 48.59 months, p = 0.041) and initial RAIT dose >100 mCi (50.50 months vs. 38.00 months, p = 0.030). Conclusion We found the sTg and pa-TgAb conducts is a good predictor of the efficacy of RAIT in TgAb-positive DTC patients. It can play a very positive and important role in optimizing treatment, improving prognosis, and reducing the burden of patients.
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Affiliation(s)
- Na Han
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chenghui Lu
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jiao Li
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Congcong Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zilong Zhao
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- Department of Nuclear Medicine, Ordos Central Hospital, Ordos, Inner Mongolia, China
| | - Yingying Zhang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xinfeng Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zengmei Si
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guoqiang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zenghua Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Fengqi Li
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xufu Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Ju Y, Wang L, Cheng F, Huang F, Chen X, Song Q, Xiao J, Zhu X, Jia H. Comparing the efficacy of thyroglobulin and thyroglobulin/ thyroid-stimulating hormone ratio models in predicting a successful response to radioactive iodine therapy. BMC Endocr Disord 2023; 23:19. [PMID: 36670396 PMCID: PMC9854025 DOI: 10.1186/s12902-022-01261-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/27/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The thyroglobulin (Tg)/ thyroid-stimulating hormone (TSH) ratio has manifested to be a reliable marker for predicting prognosis in patients with differentiated thyroid carcinoma (DTC). The objective of this study was to compare the efficacy of Tg and Tg/TSH ratio models in predicting a successful response to radioactive iodine therapy. METHODS One thousand six hundred forty-two DTC patients receiving 131I radiotherapy were finally enrolled in this retrospective study. The patients were divided into a training set (n = 973) and a validation set (n = 669) by the patient consultation time (July 2019). A receiver-operating characteristic curve was constructed for Tg and the Tg/TSH ratio to establish their cutoffs. Then, the variables were screened by univariate logistic regression and incorporated into logistic prediction models by stepwise regression, where Tg/TSH was excluded from model 1 and Tg was excluded from model 2. RESULTS In 1642 enrolled DTC patients, the first 131I radiotherapy had an excellent response in 855 patients. The cut-offs for Tg level and Tg/TSH ratio were 3.40 ng/ mL [area under the curve (AUC): 0.789] and 36.03 ng/mIU (AUC: 0.788), respectively. In addition, the AUC of the model including Tg was higher than that of the model including Tg/TSH in both the training set (0.837 vs 0.833) and the testing set (0.854 vs 0.836). CONCLUSIONS Both Tg and Tg/TSH ratios could be considered predictors of the effects of the first 131I ablative therapy. However, the prediction model including Tg performed better than the model including Tg/TSH.
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Affiliation(s)
- Yanli Ju
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Jinan, Shandong, 250012, China
| | - Lihua Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Jinan, Shandong, 250012, China
| | - Fang Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Jinan, Shandong, 250012, China
| | - Fengyan Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Jinan, Shandong, 250012, China
| | - Xueyu Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Jinan, Shandong, 250012, China
| | - Qingqing Song
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Jinan, Shandong, 250012, China
| | - Juan Xiao
- Center of Evidence-Based Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, No. 247 Beiyuan Street, Jinan, Shandong, 250033, China
| | - Xiaolu Zhu
- Department of Nuclear Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, No. 247 Beiyuan Street, Jinan, Shandong, 250033, China.
| | - Hongying Jia
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Jinan, Shandong, 250012, China.
- Center of Evidence-Based Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, No. 247 Beiyuan Street, Jinan, Shandong, 250033, China.
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Nóbrega G, Cavalcanti M, Leite V, Vilar L, Brandão SCS. Value of stimulated pre-ablation thyroglobulin as a prognostic marker in patients with differentiated thyroid carcinoma treated with radioiodine. Endocrine 2022; 76:642-647. [PMID: 35237910 DOI: 10.1007/s12020-022-03021-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 02/16/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine which Thyroglobulin (Tg) level after levothyroxine (LT4) withdrawal (stimulated thyroglobulin - sTg) measured before radioiodine therapy (RAIT) is able to predict incomplete response to treatment of differentiated thyroid carcinoma (DTC) with greater sensitivity and specificity one year after initial treatment with I131. METHODS A chart review was performed in which 375 patients with DTC treated with RAIT were included. The sTg was measured in all patients prior to treatment with I131. Follow up were then performed one year later. Initial sTg levels were associated to DTC outcomes. A receiver operating characteristic (ROC) curve was performed to achieve a sTg level able to predict which patients would have a greater chance of having an incomplete response to RAIT. RESULTS Incomplete response to treatment was found in 122 patients (32.5%), this group had a mean sTg of 23.2 ng/mL. ROC curve showed that the optimal cut-off sTg level was 4.4 ng/mL. (sensitivity: 72.1%; specificity: 72.3%; accuracy: 72.2%; positive predictive value of 55.7%; and negative predictive value: 84.3%). CONCLUSION sTg pre-ablation is a valuable predictor of DTC incomplete response to treatment one year after RAIT. Levels of 4.4 ng/ml or more showed higher accuracy to predict this outcome.
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Affiliation(s)
- Giulliana Nóbrega
- Endocrinology Department, Paraíba Federal University (UFPB), João Pessoa, Paraíba, Brazil.
| | - Milena Cavalcanti
- Medical Sciences Department, Pernambuco Federal University (UFPE), Recife, Pernambuco, Brazil
| | - Verônica Leite
- Clinical Medicine Department, Clinical Hospital, UFPE, Recife, Pernambuco, Brazil
| | - Lúcio Vilar
- Chief Of The Endocrinology Department, Clinical Hospital, UFPE, Recife, Pernambuco, Brazil
| | - Simone Cristina Soares Brandão
- Chief Of Nuclear Medicine Service, Clinical Hospital, And Associated Medicine Professor, UFPE, Recife, Pernambuco, Brazil
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Colenci R, Minicucci MF, Soares CSP, de Oliveira CC, de Alencar Marques ME, Tagliarini JV, da Silva Mazeto GMF. Is there a relationship between preoperative cytological diagnosis and evolution in patients with differentiated thyroid carcinoma? A retrospective study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:237-246. [PMID: 35420266 PMCID: PMC9832890 DOI: 10.20945/2359-3997000000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Cytological analysis and Bethesda classification of thyroid nodules is the standard method of diagnosing differentiated thyroid carcinoma (DTC). However, even for nodules with a non-malignant cytological diagnosis, there is a not insignificant risk of cancer. There are doubts whether this lack of certainty would influence patient prognosis. Our aim was to compare patients with DTC, classified according to the preoperative cytological diagnosis, regarding their evolution. Methods A retrospective study was carried out with 108 DTC patients submitted to total thyroidectomy (TT) between 2009 and 2015, divided into three groups according to preoperative cytological diagnosis (Bethesda classification): classes I/II, III/IV, and V/VI. Groups were compared for evolution considering response to treatment at last evaluation as well as time disease free. Statistical analysis used ANOVA, chi squared, and Kaplan-Meier curves with p<0.05 considered significant. Results Groups differed for time between nodule puncture and TT [in months; V/VI (2.35 ± 2.48) < III/IV (7.32 ± 6.34) < I/II (13.36 ± 8.9); p < 0.0001]. There was no significant difference between groups for evolution at final evaluation (disease free status; classes I/II: 71.4%; classes III/IV: 60%; classes V/VI: 66.6%; p = 0.7433), as well as time disease free (in months; classes I/II: 34.57 ± 25.82; classes III/IV: 38.04 ± 26.66; classes V/VI: 30.84 ± 26.34; p = 0.3841). Conclusion DTC patients classified according to preoperative cytological diagnosis did not differ for evolution. Although patients with non-malignant cytological diagnoses were submitted to TT later, this did not affect the evolution of the cases.
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Affiliation(s)
- Renato Colenci
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil
| | - Marcos Ferreira Minicucci
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil
| | - Carlos Segundo Paiva Soares
- Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil
| | - Cristiano Claudino de Oliveira
- Departamento de Patologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil
| | | | - José Vicente Tagliarini
- Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil
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Pan M, Li Z, Jia M, Lu X. Combination of Stimulated Thyroglobulin and Antithyroglobulin Antibody Predicts the Efficacy and Prognosis of 131I Therapy in Patients With Differentiated Thyroid Cancer Following Total Thyroidectomy: A Retrospective Study. Front Endocrinol (Lausanne) 2022; 13:857057. [PMID: 35464061 PMCID: PMC9020646 DOI: 10.3389/fendo.2022.857057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to analyze the diagnostic ability of the combination of stimulated thyroglobulin (sTg) and antithyroglobulin antibody (TgAb) in predicting the efficacy and prognosis of radioactive iodine (131I) therapy (RAIT) in patients with differentiated thyroid carcinomas (DTCs) after total thyroidectomy (TT). METHODS This retrospective study comprised 409 DTC patients who underwent 131I treatment following TT in the First Affiliated Hospital of Zhengzhou University from January 2019 to August 2020, and they were followed up to November 2021. Patients were divided into the successful ablation and the unsuccessful ablation group based on the classification of the efficacy of RAIT in the 2015 American Thyroid Association guidelines. The clinical characteristics and the efficacy of the initial RAIT were evaluated. The cutoffs of preablation sTg, sTg/thyroid-stimulating hormone (TSH) ratio, and sTg×TgAb product were calculated to predict the efficacy of RAIT. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for unsuccessful ablation. Kaplan-Meier curves were used to estimate the prognostic value of sTg×TgAb product affecting progression-free survival (PFS). RESULTS The cohort consisted of 222 cases in the successful ablation group and 187 cases in the unsuccessful ablation group. Between the two groups, preablation sTg, sTg/TSH ratio, and sTg×TgAb product were significantly higher in the unsuccessful ablation group. The area under the curve (AUC) of the sTg×TgAb product was the highest among the above three factors. The cutoffs for the worse therapeutic effect of the initial RAIT in sTg, sTg/TSH ratio, and sTg×TgAb were >2.99 ng/ml, >0.029 mg/IU, and >34.18, respectively. STg >2.99 ng/ml and sTg×TgAb product >34.18 were independent risk factors for unsuccessful ablation. Patients with sTg×TgAb product >34.18 had shorter PFS than that of patients with sTg×TgAb product ≤34.18. In separate analyses of TgAb-negative and TgAb-positive subgroups, higher sTg×TgAb was both associated with a lower success rate of RAIT and a shorter PFS. CONCLUSION STg×TgAb product predicted the efficacy and prognosis of 131I therapy for both TgAb-negative and TgAb-positive DTC patients before the initial 131I treatment following TT. Thus, it can be used as a clinical reference indicator for the surveillance of DTC patients.
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Affiliation(s)
| | | | - Meng Jia
- *Correspondence: Meng Jia, ; Xiubo Lu,
| | - Xiubo Lu
- *Correspondence: Meng Jia, ; Xiubo Lu,
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Li S, Ren C, Gong Y, Ye F, Tang Y, Xu J, Guo C, Huang J. The Role of Thyroglobulin in Preoperative and Postoperative Evaluation of Patients With Differentiated Thyroid Cancer. Front Endocrinol (Lausanne) 2022; 13:872527. [PMID: 35721746 PMCID: PMC9200986 DOI: 10.3389/fendo.2022.872527] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/29/2022] [Indexed: 12/02/2022] Open
Abstract
Thyroglobulin (Tg) is secreted by thyroid follicular cells and stored in the thyroid follicular lumen as a component of thyroid hormone. It is known that both benign and well-differentiated malignant thyroid tissue can secrete Tg. In recent years, growing lines of evidence have shown that Tg plays an important role in the diagnosis and metastasis of preoperative differentiated thyroid carcinoma (DTC). The levels of Tg, whether in the serum or in a fine-needle aspiration washout fluid, are usually viewed as an excellent indicator in the monitoring of postoperative DTC, including the guidance and evaluation of radioactive iodine ablation. Nevertheless, some factors limit the application of Tg, such as the method used to measure Tg and the presence of Tg antibodies. This review aimed to summarize the role of Tg in the preoperative and postoperative evaluation of patients with DTC, and the factors influencing Tg. This review could provide a reference for a more accurate application of Tg in patients with DTC.
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Affiliation(s)
| | - Chutong Ren
- *Correspondence: Jiangsheng Huang, ; Chutong Ren,
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De Marchi AF, de Macedo ABT, Soares CSP, Bolfi F, Iessi MRG, de Oliveira CC, Koga KH, Moriguchi SM, Tagliarini JV, da Silva Mazeto GMF. Thyroglobulin/thyrotropin ratio for predicting long-term response in differentiated thyroid carcinoma: a retrospective study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:428-435. [PMID: 34283903 PMCID: PMC10522177 DOI: 10.20945/2359-3997000000387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Thyrotropin-stimulated thyroglobulin (STg) after total thyroidectomy is a prognosis marker for differentiated thyroid carcinoma (DTC). As Tg level is influenced by thyrotropin (TSH), perhaps the STg/TSH ratio is also a prognosis marker for these tumours. We aimed to compare STg/TSH ratio and first STg level in differentiated thyroid carcinoma patients for their ability to predict the long-term response to initial treatment. METHODS This retrospective study evaluated data from 181 DTC patients for first (1st) STg and STg/TSH ratio, at 1-3 months post-total thyroidectomy and before iodine-131 therapy, according to response to initial therapy [Excellent/Indeterminate or Incomplete (Biochemical/Structural)] observed at final evaluation, and with the survival time with excellent/indeterminate response. RESULTS Cases with incomplete response presented higher STg level [225.13 ± 585.26 ng/mL versus (vs) 20.4 ± 192.9 ng/mL; p < 0.001] and STg/TSH ratio (3.01 ± 7.8 vs 0.27 ± 2.58; p < 0.001). Cutoffs of 5 ng/mL for STg and 0.085 for STg/TSH displayed sensitivities of 76.7% and 76.9%, and specificities of 79.2% and 82.6%, respectively, in predicting response to therapy. Values below these cutoffs were associated with longer survival time in excellent/indeterminate response (140.4 vs 15.9 and 144.6 vs 15.9 months, respectively). CONCLUSION STg/TSH ratio has a similar performance to the 1st STg in predicting long-term response to initial therapy.
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Affiliation(s)
- Adriano Francisco De Marchi
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil
| | - Ana Bárbara Trizzotti de Macedo
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil
| | - Carlos Segundo Paiva Soares
- Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil
| | - Fernanda Bolfi
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil
| | - Mariana Riello Gomes Iessi
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil
| | - Cristiano Claudino de Oliveira
- Departamento de Patologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil
| | - Katia Hiromoto Koga
- Departamento de Medicina Nuclear, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil
| | - Sonia Marta Moriguchi
- Departamento de Medicina Nuclear, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil
| | - José Vicente Tagliarini
- Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil
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Szujo S, Bajnok L, Bodis B, Nagy Z, Nemes O, Rucz K, Mezosi E. The Prognostic Role of Postablative Non-Stimulated Thyroglobulin in Differentiated Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13020310. [PMID: 33467717 PMCID: PMC7830405 DOI: 10.3390/cancers13020310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/03/2022] Open
Abstract
Simple Summary In the management of patients with differentiated thyroid cancer, thyroglobulin (Tg) is used as a tumor marker to predict residual disease. After surgery, the presence or absence of persistent disease and the risk for recurrent disease should be assessed. Risk categories may be changed during the course of disease; the reclassification of patients influences the management of the disease and the intensity of follow-up. The diagnostic and prognostic roles of postoperative stimulated and one-year postablative non-stimulated Tg was evaluated. The individual lowest and highest non-stimulated Tg values during the entire follow-up were also assessed. Non-stimulated Tg values had excellent diagnostic accuracy in predicting structural disease, and the risk classification based on these was significantly more accurate regarding outcome than that based on the postoperative stimulated Tg. Analysis of the lowest and highest Tg values highlighted that a patient’s risk category can be revised based on a single Tg measurement. Abstract Thyroglobulin (Tg) is the most important tumor marker in differentiated thyroid cancer (DTC). The aim of this study was to assess the diagnostic and prognostic roles of postoperative stimulated and postablative lowest, highest, and one-year non-stimulated Tg values obtained during the follow-up of patients with DTC. In this retrospective study, 222 radioiodine-treated, anti-thyroglobulin antibody (TgAb)-negative DTC patients having at least 9 months’ follow-up time were included (172 papillary and 50 follicular cancers; median age: 48 (from 15 to 91) years; female–male ratio: 158/64; median (quartiles) follow-up time: 54 (22–97) months). The 2015 American Thyroid Association guidelines were applied as criteria of the therapeutic response. Postoperative stimulated Tg values had significantly lower diagnostic accuracy than any of the non-stimulated postablative Tg values. One-year non-stimulated Tg had excellent prognostic value for structural disease: a cut-off value of 0.85 ng/mL had an 88.1% diagnostic accuracy. If the Tg value did not decrease below 0.75 ng/mL at any time during follow-up, the risk of residual disease was 25 times higher. The highest non-stimulated Tg during follow-up was the best predictor of residual disease (e.g., a Tg value exceeding 7.7 ng/mL indicated a 30-fold increase in risk). Non-stimulated Tg values measured during follow-up have excellent diagnostic accuracy to predict structural disease in DTC patients. The risk classification of a patient can safely be modified based on even a single Tg measurement.
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Affiliation(s)
- Szabina Szujo
- Ist Department of Medicine, Medical School, University of Pecs, 13 Ifjusag, H-7624 Pecs, Hungary; (S.S.); (L.B.); (B.B.); (O.N.); (K.R.)
| | - Laszlo Bajnok
- Ist Department of Medicine, Medical School, University of Pecs, 13 Ifjusag, H-7624 Pecs, Hungary; (S.S.); (L.B.); (B.B.); (O.N.); (K.R.)
| | - Beata Bodis
- Ist Department of Medicine, Medical School, University of Pecs, 13 Ifjusag, H-7624 Pecs, Hungary; (S.S.); (L.B.); (B.B.); (O.N.); (K.R.)
| | - Zsuzsanna Nagy
- IInd Department of Medicine and Nephrological Center, Medical School, University of Pecs, 1 Pacsirta, H-7624 Pecs, Hungary;
| | - Orsolya Nemes
- Ist Department of Medicine, Medical School, University of Pecs, 13 Ifjusag, H-7624 Pecs, Hungary; (S.S.); (L.B.); (B.B.); (O.N.); (K.R.)
| | - Karoly Rucz
- Ist Department of Medicine, Medical School, University of Pecs, 13 Ifjusag, H-7624 Pecs, Hungary; (S.S.); (L.B.); (B.B.); (O.N.); (K.R.)
| | - Emese Mezosi
- Ist Department of Medicine, Medical School, University of Pecs, 13 Ifjusag, H-7624 Pecs, Hungary; (S.S.); (L.B.); (B.B.); (O.N.); (K.R.)
- Szentagothai Research Centre, University of Pecs, 20 Ifjusag, H-7624 Pecs, Hungary
- Correspondence: ; Tel.: +36-30-565-4155; Fax: +36-72-536-148
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12
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Karvounis E, Kappas I, Angelousi A, Makris GM, Siamatras TD, Kassi E. The diagnostic and predictive accuracy of thyroglobulin to TSH ratio and TSH to thyroglobulin ratio in detecting differentiated thyroid carcinoma in normothyroid patients with thyroid nodules: A retrospective cohort study and systematic review of the literature. Oncol Rev 2021; 14:439. [PMID: 33505608 PMCID: PMC7814274 DOI: 10.4081/oncol.2020.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/09/2020] [Indexed: 11/23/2022] Open
Abstract
The purpose of the present study is to examine the diagnostic and predictive accuracy of the thyroglobulin (Tg) to thyroid stimulating hormone (TSH) and TSH/Tg ratios in normothyroid patients with differentiated thyroid cancer (DTC). We conducted a retrospective cohort study evaluating the diagnostic accuracy of the serum Tg/TSH and TSH/Tg ratios in normothyroid patients with thyroid nodules. We also systematically searched the international literature using the Medline, Cochrane's CENTRAL, Scopus, Clinicaltrials.gov, EMBASE, and Google Scholar databases for evidence concerning the diagnostic and predictive accuracy of these ratios. Overall, 374 patients were identified in our cohort study of whom 240 were treated for benign disease and 134 were treated for DTC. Significant differences were noted in the Tg/TSH and TSH/Tg values among cases with malignant and benign disease (P=0.020). However, the diagnostic ROC curve did not confirm these results (Tg/TSH=0.572 and TSH/Tg=0.428). After searching the international literature, we identified 8 studies. The majority of the included data reported significant differences among patients with benign/malignant disease and those with successful iodine therapy compared to those with disease relapse. However, the clinical relevance was clearer among studies that investigated the usefulness of these ratios in predicting recurrent disease. The findings of our study support that the Tg/TSH ratio increases in patients with DTC and can, thus, become useful in the future as a predictive marker of ablative 131I therapy success. However, given the significant variability of Tg its diagnostic accuracy remains to date minimal; thus, the actual cut-off value that can be used to discriminate cancer cases from benign disease has not been determined yet.
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Affiliation(s)
- Evangelos Karvounis
- Department of Endocrine Surgery Center of Excellence, Euroclinic Hospital, Athens
| | - Ioannis Kappas
- Department of Endocrine Surgery Center of Excellence, Euroclinic Hospital, Athens
| | - Anna Angelousi
- Department of Internal Medicine, Laiko hospital, National and Kapodistrian University of Athens
| | | | - Thomas D Siamatras
- Department of Endocrine Surgery Center of Excellence, Euroclinic Hospital, Athens
| | - Eva Kassi
- Department of Internal Medicine, Laiko hospital, National and Kapodistrian University of Athens.,Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Rui ZY, Liu Y, Zheng W, Wang X, Meng ZW, Tan J, Li N, Jia Q. A retrospective study of the risk factors and the prognosis in patients with papillary thyroid carcinoma depending on the number of lymph node metastasis. Clin Exp Med 2021; 21:277-286. [PMID: 33386568 DOI: 10.1007/s10238-020-00675-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/20/2020] [Indexed: 02/07/2023]
Abstract
To retrospectively analyze the risk factors and the prognosis according to the number of lymph node metastases (LNMs) in different neck compartments in papillary thyroid carcinoma (PTC) patients. In total, 962 patients with PTC were enrolled in this study. According to the methods of the 2015 American Thyroid Association, the treatment response of the patients was divided into a good prognosis and a poor prognosis. First, their clinical characteristics were summarized. Then, according to whether they had LNMs and the number of LNMs in different neck compartments, their risk factors and their prognosis were analyzed. Male sex, younger (< 45 years), extrathyroid extension (ETE), T1 staging and higher stimulated thyroglobulin (sTg) levels were the risk factors for LNM. The cutoff for a poor prognosis of the number of LNMs was > 4. Male sex, younger age, higher sTg levels and ETE were correlated with LNM > 4. Furthermore, the cutoffs for a poor prognosis of central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM) and CLNM + LLNM were > 6, > 1 and > 5, respectively. Younger age and ETE were strongly correlated with CLNM > 6. Male sex, younger age, higher sTg levels and ETE were correlated with LLNM > 1. Younger age, ETE and higher sTg levels were correlated with CLNM + LLNM > 5. Further analysis revealed a positive correlation between CLNM and LLNM. We should pay more attention to LNMs in PTC patients who are male, are of a younger age, have ETE, T1 staging and have higher sTg levels. The neck regional LNMs should be correctly evaluated to guide the surgical options for the neck LNMs in PTC. When the number of LNMs in different neck compartments has exceeded the cutoff value, they can be considered as predictors of the outcome of 131I treatment.
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Affiliation(s)
- Zhong Ying Rui
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Yang Liu
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Wei Zheng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China.
| | - Xuan Wang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Zhao Wei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Ning Li
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Qiang Jia
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
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Wang C, Diao H, Ren P, Wang X, Wang Y, Zhao W. Efficacy and Affecting Factors of 131I Thyroid Remnant Ablation After Surgical Treatment of Differentiated Thyroid Carcinoma. Front Oncol 2019; 8:640. [PMID: 30619772 PMCID: PMC6306449 DOI: 10.3389/fonc.2018.00640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/06/2018] [Indexed: 11/13/2022] Open
Abstract
Purpose: Radioiodine (131I) thyroid remnant ablation is an important treatment of differentiated thyroid carcinoma (DTC) and various factors affecting its efficacy have been reported but not well defined. The aim of our study was to evaluate the efficacy and the affecting factors of 131I ablation after total or near-total thyroidectomy in a relative large DTC cohort. Methods: 261 DTC patients with negative thyroglobulin antibody received 100-200 mCi 131I for thyroid remnant ablation after total or near-total thyroidectomy between January 2012 and October 2015 in our hospital. The efficacy and affecting factors of 131I ablation therapy were retrospectively investigated. Results: The success rate of the first 131I thyroid remnant ablation was 65.90%. Univariate analysis demonstrated that larger tumor size, higher level of pre-ablation stimulated thyroglobulin (sTg), intermediate to high risk stratification for recurrence, and lymph node and distant metastases were associated with a lower success rate of the first 131I ablation (all p < 0.05). Multivariate logistic regression analysis showed that tumor size, pre-ablation sTg, and lymph node and distant metastases were independent factors affecting the efficacy of the first 131I ablation. Areas under receiver operating characteristic curves for sTg, sTg/TSH ratio, and tumor size to predict unsuccessful ablation were 0.831, 0.824, and 0.648, respectively. The threshold values were 4.595 ng/ml, 0.046 mg/IU, and 1.350 cm, respectively. The sensitivities were 95.51, 96.63, and 73.03% and the specificities were 64.54, 61.63, and 49.41%, respectively. The excellent response (ER) ratio of the successful group was significantly higher than that of the unsuccessful group. Conclusions: The efficacy of the first 131I thyroid remnant ablation after surgical treatment of DTC is well demonstrated, and tumor size, pre-ablation sTg, lymph node, and distant metastases are independent factors affecting its efficacy.
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Affiliation(s)
- Chen Wang
- Department of Endocrine and Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hongcui Diao
- Department of Endocrine and Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ping Ren
- Department of Endocrine, Yiyuan County People's Hospital, Zibo, China
| | - Xufu Wang
- Department of Nuclear Medicine, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yangang Wang
- Department of Endocrine and Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjuan Zhao
- Department of Endocrine and Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
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Prpić M, Franceschi M, Romić M, Jukić T, Kusić Z. THYROGLOBULIN AS A TUMOR MARKER IN DIFFERENTIATED THYROID CANCER - CLINICAL CONSIDERATIONS. Acta Clin Croat 2018; 57:518-527. [PMID: 31168186 PMCID: PMC6536288 DOI: 10.20471/acc.2018.57.03.16] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
SUMMARY – Initial treatment of the majority of patients with differentiated thyroid cancer (DTC) includes total thyroidectomy. Postoperative ablation therapy with radioactive iodine (I-131) is indicated in all high-risk patients, however, there is disagreement regarding its use in low- and intermediate-risk patients. Over the last few decades, thyroglobulin (Tg) has been established as the primary biochemical tumor marker for patients with DTC. Thyroglobulin can be measured during thyroid hormone therapy or after thyroid-stimulating hormone (TSH) stimulation, through thyroid hormone withdrawal or the use of human recombinant TSH. In many studies, the cut-off value for adequate Tg stimulation is a TSH value ≥30 mIU/L. However, there is an emerging body of evidence suggesting that this long-established standard should be re-evaluated, bringing this threshold into question. Recently, a risk stratification system of response to initial therapy (with four categories) has been introduced and Tg measurement is one of the main components. The relationship between the Tg/TSH ratio and the outcome of radioiodine ablation has also been studied, as well as clinical significance of serum thyroglobulin doubling-time. The postoperative serum Tg value is an important prognostic factor that is used to guide clinical management, and it is the most valuable tool in long term follow-up of patients with DTC.
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Affiliation(s)
| | - Maja Franceschi
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Croatian Academy of Sciences and Arts, Zagreb, Croatia; 5Aviva Polyclinic, Zagreb, Croatia
| | - Matija Romić
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Croatian Academy of Sciences and Arts, Zagreb, Croatia; 5Aviva Polyclinic, Zagreb, Croatia
| | - Tomislav Jukić
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Croatian Academy of Sciences and Arts, Zagreb, Croatia; 5Aviva Polyclinic, Zagreb, Croatia
| | - Zvonko Kusić
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Croatian Academy of Sciences and Arts, Zagreb, Croatia; 5Aviva Polyclinic, Zagreb, Croatia
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Overwhelming rapid metabolic and structural response to apatinib in radioiodine refractory differentiated thyroid cancer. Oncotarget 2018; 8:42252-42261. [PMID: 28178685 PMCID: PMC5522064 DOI: 10.18632/oncotarget.15036] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/08/2017] [Indexed: 12/31/2022] Open
Abstract
Currently, patients with radioiodine refractory differentiated thyroid cancer (RAIR-DTC) have limited treatment options. In this study, we aimed to assess the short-term efficacy and safety of apatinib in RAIR-DTC. Ten adult patients were prospectively enrolled to receive oral apatinib (750 mg q.d). The primary endpoints were change in serum thyroglobulin (Tg) concentration, disease control rate (DCR) and objective response rate (ORR) based on RECIST 1.1 criteria. The secondary endpoints included change in glucose metabolism, evaluated by maximum standard uptake value (SUVmax), and safety. As early as 2 weeks after apatinib treatment, the serum Tg concentration decreased by 21.0% in 8 patients available for detection without interference, and a further sharp decline by 81.4% compared with the baseline level occurred at 8 weeks post-treatment. The DCR and ORR were 100% (10/10) and 90% (9/10), respectively. The sum of tumor diameter shrank to 22.8±8.1 mm from 38.8±15.7 mm (P=0.001). Moreover, a significant decrease in SUVmax was observed from 6.53±5.14 to 2.56±1.67 and 2.45±1.48 at 4-week and 8-week time-points after treatment (P=0.032 and 0.020), respectively. The common grade 3 adverse events (AEs) included hand-foot-skin reaction (50%), hypertension (30%), and hypocalcemia (20%). No severe AE related to apatinib was observed during treatment. Hence, apatinib seems to be a promising therapeutic option for RAIR-DTC patients. Apart from RECIST 1.1 criteria, the biochemical marker (Tg) and glucose metabolism index (SUVmax) could be adopted in assessing the early response to TKI in RAIR-DTC.
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17
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Amui IDO, Tagliarini JV, Castilho EC, Marques MDA, Kiy Y, Corrente JE, Mazeto GMFS. The first postoperative-stimulated serum thyroglobulin is a prognostic factor for thyroid microcarcinomas. Braz J Otorhinolaryngol 2017; 85:37-42. [PMID: 29157630 PMCID: PMC9442841 DOI: 10.1016/j.bjorl.2017.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/02/2017] [Accepted: 10/07/2017] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Endogenous thyroid-stimulating hormone-stimulated thyroglobulin collected after total thyroidectomy is a useful predictor of better prognosis in patients with differentiated thyroid carcinomas in general, but studies with microcarcinomas are scarce. OBJECTIVE To assess whether the first postoperative stimulated thyroglobulin measurement is a prognostic factor in patients with microcarcinoma. METHODS The medical data of 150 differentiated thyroid carcinoma patients were studied retrospectively, and 54 (36%) cases with microcarcinoma were selected. The first postoperative stimulated thyroglobulin (1st stimulated thyroglobulin), measured after thyroidectomy, initial presentation data, and microcarcinomas treatment were assessed regarding outcome. Worse prognosis was defined as neoplasm persistence/recurrence. RESULTS Persistence/recurrence occurred in 27.8% of the cases. These patients were identified according to the following parameters: receiving more than one 131iodine dose (100% vs. 0%; p<0.0001); accumulated 131iodine dose (232.14±99.09 vs. 144±33.61mCi; p<0.0001); presented active disease in the last assessment (53.3% vs. 0%; p<0.0001); follow-up time (103.07±61.27 vs. 66.85±70.14 months; p=0.019); and 1st stimulated thyroglobulin (19.01±44.18 vs. 2.19±2.54ng/dL; p<0.0001). After multivariate logistic regression, only the 1stSTg [odds ratio=1.242; 95% confidence interval: 1.022-1.509; p=0.029] and follow-up time (odds ratio=1.027; 95% confidence interval: 1.007-1.048; p=0.007) were independent predictors of risk of persistence/recurrence. The cutoff point of 1.6ng/dL for the 1st stimulated thyroglobulin was significantly associated with disease persistence/recurrence [area under the curve=0.713 (p=0.019)]. CONCLUSION The first stimulated thyroglobulin predicted disease persistence/recurrence in patients with microcarcinoma.
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Affiliation(s)
- Isabela de Oliveira Amui
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu, SP, Brazil
| | - José Vicente Tagliarini
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), Faculdade de Medicina de Botucatu, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Botucatu, SP, Brazil
| | - Emanuel C Castilho
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), Faculdade de Medicina de Botucatu, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Botucatu, SP, Brazil
| | - Mariângela de Alencar Marques
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), Faculdade de Medicina de Botucatu, Departamento de Patologia, Botucatu, SP, Brazil
| | - Yoshio Kiy
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), Faculdade de Medicina de Botucatu, Departamento de Doenças Tropicais e Diagnóstico por Imagem, Botucatu, SP, Brazil
| | - José Eduardo Corrente
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), Instituto de Biociências, Departamento de Bioestatística, Botucatu, SP, Brazil
| | - Gláucia M F S Mazeto
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu, SP, Brazil.
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