可疑甲状腺球蛋白增高性分化型甲状腺癌患者 经131I治疗后的临床转归.

Background and purpose: The prognosis of differentiated thyroid cancer (DTC) patients with suspicious high thyroglobulin (Tg) concentration and without explicit structural lesions varies from each other, hence the clinical treatment decisions including 131I therapy remain controversial. This study aimed to explore the effects of 131I treatment and the therapeutic dose on the clinical outcome of these patients. Methods: The study included 138 DTC patients treated in Department of Nuclear Medicine, Peking Union Medical College Hospital from 2007 to 2021, who had undergone total thyroidectomy and subsequent 131I therapy. All patients were divided into 3 groups as low dose (dose=1.11 GBq), medium dose (1.11 GBq＜dose≤3.70 GBq) and high dose (3.70 GBq＜dose≤7.40 GBq) according to the dose of 131I therapy. We compared the short-term and end-of period response to therapy among these three groups, and further observed the clinical outcome of patients with biochemical incomplete response (BIR) after initial treatment. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of stimulated Tg (sTg) levels in patients with structural incomplete response (SIR) and distant metastasis. Results: For the short-term response, the rate of excellent response (ER) was 6.7%, 13.5% and 7.0% in low, medium and high dose group, respectively. The short-term response showed no statistically significant difference among three groups (H=1.02, P=0.60). The end-of-period response among the three groups under routine follow-up also showed no significant difference (H=2.94, P=0.23). No significant difference was observed in the clinical outcome of patients with BIR after routine follow-up and second 131I treatment (U=324.5, P=0.15). The diagnostic critical point (DCP) of sTg to predict SIR and distant metastasis was 27.5 and 61.7 ng/mL, respectively. Conclusion: DTC patients with suspicious high Tg concentration has high recurrence risk, taking 27.5 ng/mL as the cut-off of sTg is helpful to identify the patients with high recurrence risk early. 131I treatment is helpful for these patients to achieve ER as soon as possible. However, highdose 131I did not have greater benefits on the prognosis of these patients. Second 131I treatment showed no further benefit for BIR patients. [ABSTRACT FROM AUTHOR]