Is second 131I treatment necessary for differentiated thyroid cancer patients and who could not benefit from it? A real-world retrospective study in China.

IF 2.5 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Canran Xiao, Ruoxin Xu, Yao Luo, Zeqing Xu, Caihua Tang
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Abstract

Background: The efficacy of a second radioactive iodine-131 (131I) treatment in patients with differentiated thyroid cancer (DTC) who did not achieve an excellent response (ER) following initial 131I therapy remains controversy and the population that would derive limited benefit from it is currently unclear.

Objectives: The aim of this retrospective study was to assess the efficacy of the second 131I treatment in DTC patients with non-ER after the initial 131I therapy, and to identify potential risk factors associated with non-benefit of the second 131I treatment.

Methods: 127 DTC patients who underwent two 131I treatments following thyroidectomy were included in this study, and the therapeutic response was evaluated after each 131I treatment. Beneficial treatment was defined as an improvement in therapy response grade (e.g. from indeterminate response to ER) after the second 131I treatment, while unbeneficial treatment was defined as no change or a downgrade in therapy response grade. The potential risk factors associated with the non-benefit of the second 131I treatment were identified using univariate and multivariate logistic regression models.

Results: Following the second 131I treatment, therapy responses of 55.12% (70/127) of patients were reclassified to a better grade indicating treatment benefit, while 44.88% (57/127) showed no change or were reclassified to a worse grade suggesting no benefit from treatment. The non-benefit of the second 131I treatment was significantly associated with potential risk factors including stimulated thyroglobulin (sTg) level ≥ 11.46 ng/mL before the second 131I treatment, primary tumor size > 2 cm, status T2 or higher, N1b status and ATA high risk.

Conclusions: The study results demonstrated that more than half of DTC patients could potentially benefit from a second 131I therapy. However, over 40% of patients exhibited no benefit in response to the second 131I treatment, suggesting potential overtreatment for this subgroup. Therefore, clinicians should exercise meticulous and precise decision-making based on identified risk factors when considering the necessity of a second 131I treatment.

分化型甲状腺癌患者是否有必要接受第二次131I治疗?中国的一项真实世界回顾性研究。
背景:分化型甲状腺癌(DTC)患者在接受初次131I治疗后未获得极佳反应(ER),对其进行第二次放射性碘131(131I)治疗的疗效仍存在争议,目前尚不清楚哪些人群可从中获得有限的益处:这项回顾性研究旨在评估初次131I治疗后未获得ER的DTC患者接受第二次131I治疗的疗效,并确定与第二次131I治疗无益相关的潜在风险因素。第二次 131I 治疗后治疗反应等级有所改善(如从不确定性反应到 ER)即为有益治疗,治疗反应等级无变化或下降即为无益治疗。利用单变量和多变量逻辑回归模型确定了与第二次 131I 治疗无益相关的潜在风险因素:结果:在第二次 131I 治疗后,55.12%(70/127)的患者的治疗反应重新分级为较好等级,表明治疗获益,而 44.88%(57/127)的患者治疗反应无变化或重新分级为较差等级,表明治疗无获益。第二次131I治疗无获益与潜在风险因素显著相关,包括第二次131I治疗前刺激甲状腺球蛋白(sTg)水平≥11.46纳克/毫升、原发肿瘤大小>2厘米、状态为T2或以上、N1b状态和ATA高风险:研究结果表明,半数以上的 DTC 患者有可能从第二次 131I 治疗中获益。然而,超过 40% 的患者在接受第二次 131I 治疗后并无获益,这表明该亚组患者可能存在过度治疗的情况。因此,临床医生在考虑是否有必要进行第二次 131I 治疗时,应根据已确定的风险因素做出缜密而精确的决策。
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来源期刊
Annals of Nuclear Medicine
Annals of Nuclear Medicine 医学-核医学
CiteScore
4.90
自引率
7.70%
发文量
111
审稿时长
4-8 weeks
期刊介绍: Annals of Nuclear Medicine is an official journal of the Japanese Society of Nuclear Medicine. It develops the appropriate application of radioactive substances and stable nuclides in the field of medicine. The journal promotes the exchange of ideas and information and research in nuclear medicine and includes the medical application of radionuclides and related subjects. It presents original articles, short communications, reviews and letters to the editor.
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