Endocrine · 2025
Impact of thyroglobulin changes on clinical outcomes of differentiated thyroid cancer with biochemical incomplete response.
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Li Xiaohui, Tian Tian, Shi Kexin, Sun Chenyu, Huang Rui
Аннотация
PURPOSE: Partial patients with biochemical incomplete response (BIR) after initial therapy for differentiated thyroid cancer (DTC) may progress to structural recurrence during follow-up. For better-individualized care, this study analyzed predictors of structural recurrence in patients with BIR after initial radioactive iodine therapy (RAIT).
METHODS: A retrospective study was conducted on 4,263 patients with DTC who underwent thyroidectomy and initial RAIT between June 2009 and August 2023. Patients with either suppressed thyroglobulin (Sup-Tg) > 1 ng/mL or stimulated Tg (Sti-Tg) > 10 ng/mL and negative anti-Tg antibodies (TgAb < 40 IU/mL) without structural disease were enrolled. Pathological examination or imaging confirmed structural recurrence. Sup-Tg change level [ΔSup-Tg% = (Sup-Tg3rd - Sup-Tg2nd)/Sup-Tg2nd × 100%] and other clinicopathological parameters were used to predict structural recurrence in patients with BIR.
RESULTS: We enrolled 161 patients with a median follow-up of 6.3 years. Fourteen patients (8.7%) progressed to structural disease, 80 (49.7%) remained in BIR status, and 67 (41.6%) recovered with long-term remission. ΔSup-Tg%≥17.08% displayed high specificity (84.4%) for structural recurrence prediction (AUC = 0.705, p = 0.011). Extrathyroid extension, stage III and ΔSup-Tg% were independent predictors of structural recurrence (OR = 4.568, p = 0.038; OR = 9.594, p = 0.015; and OR = 18.781, p < 0.001, respectively). Kaplan-Meier analysis showed that these factors were associated with structural recurrence-free survival. Cox regression analysis found that patients with stage III and ΔSup-Tg%≥17.08% have a higher risk of recurrence (HR = 4.818, p = 0.015 and HR = 10.173, p < 0.001, respectively).
CONCLUSION: Longitudinal monitoring of Tg is essential and Tg change level could be used as a predictor of structural recurrence in patients with BIR.
METHODS: A retrospective study was conducted on 4,263 patients with DTC who underwent thyroidectomy and initial RAIT between June 2009 and August 2023. Patients with either suppressed thyroglobulin (Sup-Tg) > 1 ng/mL or stimulated Tg (Sti-Tg) > 10 ng/mL and negative anti-Tg antibodies (TgAb < 40 IU/mL) without structural disease were enrolled. Pathological examination or imaging confirmed structural recurrence. Sup-Tg change level [ΔSup-Tg% = (Sup-Tg3rd - Sup-Tg2nd)/Sup-Tg2nd × 100%] and other clinicopathological parameters were used to predict structural recurrence in patients with BIR.
RESULTS: We enrolled 161 patients with a median follow-up of 6.3 years. Fourteen patients (8.7%) progressed to structural disease, 80 (49.7%) remained in BIR status, and 67 (41.6%) recovered with long-term remission. ΔSup-Tg%≥17.08% displayed high specificity (84.4%) for structural recurrence prediction (AUC = 0.705, p = 0.011). Extrathyroid extension, stage III and ΔSup-Tg% were independent predictors of structural recurrence (OR = 4.568, p = 0.038; OR = 9.594, p = 0.015; and OR = 18.781, p < 0.001, respectively). Kaplan-Meier analysis showed that these factors were associated with structural recurrence-free survival. Cox regression analysis found that patients with stage III and ΔSup-Tg%≥17.08% have a higher risk of recurrence (HR = 4.818, p = 0.015 and HR = 10.173, p < 0.001, respectively).
CONCLUSION: Longitudinal monitoring of Tg is essential and Tg change level could be used as a predictor of structural recurrence in patients with BIR.