Impact of thyroglobulin changes on clinical outcomes of differentiated thyroid cancer with biochemical incomplete response.

IF 3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Pub Date : 2025-05-09 DOI:10.1007/s12020-025-04247-2

Xiaohui Li, Tian Tian, Kexin Shi, Chenyu Sun, Rui Huang

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Abstract

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-Tg_3rd - Sup-Tg_2nd)/Sup-Tg_2nd × 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.

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甲状腺球蛋白变化对生化反应不完全分化甲状腺癌临床结局的影响。

目的：分化型甲状腺癌（DTC）初始治疗后部分生化不完全缓解（BIR）的患者在随访中可能发展为结构性复发。为了更好的个性化护理，本研究分析了BIR患者在初始放射性碘治疗（RAIT）后结构性复发的预测因素。方法：对2009年6月至2023年8月期间行甲状腺切除术和初始RAIT的4263例DTC患者进行回顾性研究。采用甲状腺球蛋白抑制(su -Tg) > 1 ng/mL或刺激Tg （Sti-Tg) > 10 ng/mL和抗Tg抗体阴性(TgAb 3 - su - tg2)/ su - tg2 × 100%）及其他临床病理参数预测BIR患者的结构性复发。结果：我们纳入了161例患者，中位随访时间为6.3年。14例（8.7%）进展为结构性疾病，80例（49.7%）保持BIR状态，67例（41.6%）恢复并长期缓解。ΔSup-Tg%≥17.08%对结构复发预测具有高特异性（84.4%）（AUC = 0.705, p = 0.011）。甲状腺外扩张、III期和ΔSup-Tg%是结构性复发的独立预测因子(OR = 4.568, p = 0.038；OR = 9.594, p = 0.015；结论：Tg的纵向监测是必要的，Tg变化水平可作为BIR患者结构性复发的预测指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Endocrine ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

5.40%

发文量

295

审稿时长

1.5 months

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.