Postoperative Unstimulated Thyroglobulin Accurately Predicts Outcomes in High-Risk Differentiated Thyroid Cancer: A Retrospective Cohort Study

IF 2.4 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Clinical Endocrinology Pub Date : 2025-05-04 DOI:10.1111/cen.15260

Julia Isabel Richter Cicogna, Sophia Yada Noguchi, Adriano Namo Cury, Giovanna Marcela Vieira Della Negra, Laís de Oliveira Teles Fraga, Marcelo Soares Schalch, Rafael de Cicco, Carolina Ferraz da Silva, Rosália Do Prado Padovani

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Abstract

Objective

High-risk differentiated thyroid cancer (DTC) patients show variable outcomes. While postoperative stimulated thyroglobulin (STg) is a recognized predictive marker, the prognostic significance of unstimulated thyroglobulin (UTg) is still unexplored. This study aims to assess the prognostic value of postoperative UTg in high-risk DTC patients.

Design

Retrospective cohort study (2015–2024) at two Brazilian tertiary hospitals.

Patients

One thousand DTC patients were identified, of which 144 were high-risk. Fifty seven patients met the inclusion criteria.

Methods

Clinical, pathological, and laboratory data were collected. Outcomes were categorized as favorable (excellent/indeterminate responses) or unfavorable (biochemical/structural incomplete responses). Receiver Operating Characteristic (ROC) curves determined cutoff values for predicting outcomes and metastases.

Results

Significant predictors of unfavorable outcomes included advanced age (p = 0.048), larger tumor size (p = 0.002), higher UTg (p < 0.001), and STg (p < 0.001). UTg was an independent risk factor for 1-year outcomes (OR = 0.008; 95% CI: 0.001–0.088; p < 0.001). UTg cutoff of 2.1 ng/mL distinguished outcomes with high sensitivity (83.3%), specificity (96.0%), and accuracy (90.7%). A higher cutoff of 3.8 ng/mL identified metastases (sensitivity 86.4%, specificity 90.5%). UTg showed non-inferiority to stimulated thyroglobulin (STg) in predicting outcomes (p = 0.964) and metastasis (p = 0.980).

Conclusion

Postoperative UTg is a strong prognostic marker in high-risk DTC patients, providing a non-inferior alternative to STg with greater accessibility and fewer side effects. We propose a clinical algorithm to optimize the management of these cases. When UTg levels exceed 2.1 ng/mL, particularly higher than 3.8 ng/mL, investigation of potentially resectable metastatic foci should be considered before radioiodine therapy. Prospective studies are needed to validate this algorithm.

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术后未刺激甲状腺球蛋白准确预测高危分化甲状腺癌的预后：一项回顾性队列研究。

目的：高危分化型甲状腺癌（DTC）患者预后不一。虽然术后受刺激甲状腺球蛋白（STg）是公认的预测指标，但未受刺激甲状腺球蛋白（UTg）的预后意义尚不清楚。本研究旨在评估高危DTC患者术后UTg的预后价值。设计：在巴西两家三级医院进行回顾性队列研究（2015-2024）。患者：共发现1000例DTC患者，其中高危144例。57例患者符合纳入标准。方法：收集临床、病理及实验室资料。结果分为有利（极好/不确定的反应）和不利（生化/结构不完全的反应）。受试者工作特征（ROC）曲线确定了预测预后和转移的临界值。结果：高龄（p = 0.048）、较大肿瘤大小（p = 0.002）、较高UTg (p)是不良结局的显著预测因素。结论：术后UTg是高危DTC患者的一个强有力的预后指标，为STg提供了一个非劣等的替代方案，更容易获得，副作用更少。我们提出了一种临床算法来优化这些病例的管理。当UTg水平超过2.1 ng/mL，特别是高于3.8 ng/mL时，应在放射性碘治疗前考虑是否有可能切除转移灶。需要前瞻性研究来验证该算法。

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来源期刊

Clinical Endocrinology 医学-内分泌学与代谢

CiteScore

6.40

自引率

3.10%

发文量

192

审稿时长

1 months

期刊介绍： Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.