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Abstract：
Residual/recurrent lymph node metastase (LNM) is often found after differentiated thyroid cancer (DTC) surgery. This study aimed to investigate whether patients complicated with radioiodine-avid (131I+) lymph nodes from DTC on the initial posttherapy scan (PTS) need repeated 131I therapy.
From June 2013 to August 2022, DTC patients with 131I+ lymph nodes on the initial PTS who received at least two cycles of 131I therapy were retrospectively enrolled. They were divided into a complete response (CR) group and an incomplete response (IR) group according to their response to the initial 131I therapy based on the 2015 American Thyroid Association (ATA) guidelines.
A total of 170 DTC patients with 131I+ lymph nodes on the initial PTS were included; 42/170 (24.7%) patients were classified into the CR group and 128/170 (75.9%) were classified into the IR group according to their response to the initial 131I therapy. None of the 42 CR patients had disease progression at the subsequent follow-up, and 37/170 (21.8%) IR patients improved after repeated therapy. Univariate analysis showed that N stage (P=0.002), stimulated thyroglobulin (sTg) level before initial 131I therapy (P<0.001), LNM size (P<0.001), number of total residual/recurrent LNM (P=0.021), radioiodine-nonavid (131I-) LNM (P=0.002) and ultrasound features (P<0.001) were related to the initial treatment response. On multivariate analysis, sTg level (OR=1.186, P<0.001) and LNM size (OR=1.533, P=0.004) were independent risk factors for IR after initial 131I therapy. The optimal sTg level and LNM size cutoff value for predicting the treatment response after initial 131I therapy were 18.2 µg/l and 5mm.
This study suggested that approximately one-quarter of patients with 131I+ lymph nodes on initial PTS, especially those with N0 or N1a stage, lower sTg level, smaller LNM size, ≤2 residual/recurrent LNMs, negative ultrasound features and no 131I- LNM, remain stable after one cycle of 131I therapy and do not need repeated therapy.
From June 2013 to August 2022, DTC patients with 131I+ lymph nodes on the initial PTS who received at least two cycles of 131I therapy were retrospectively enrolled. They were divided into a complete response (CR) group and an incomplete response (IR) group according to their response to the initial 131I therapy based on the 2015 American Thyroid Association (ATA) guidelines.
A total of 170 DTC patients with 131I+ lymph nodes on the initial PTS were included; 42/170 (24.7%) patients were classified into the CR group and 128/170 (75.9%) were classified into the IR group according to their response to the initial 131I therapy. None of the 42 CR patients had disease progression at the subsequent follow-up, and 37/170 (21.8%) IR patients improved after repeated therapy. Univariate analysis showed that N stage (P=0.002), stimulated thyroglobulin (sTg) level before initial 131I therapy (P<0.001), LNM size (P<0.001), number of total residual/recurrent LNM (P=0.021), radioiodine-nonavid (131I-) LNM (P=0.002) and ultrasound features (P<0.001) were related to the initial treatment response. On multivariate analysis, sTg level (OR=1.186, P<0.001) and LNM size (OR=1.533, P=0.004) were independent risk factors for IR after initial 131I therapy. The optimal sTg level and LNM size cutoff value for predicting the treatment response after initial 131I therapy were 18.2 µg/l and 5mm.
This study suggested that approximately one-quarter of patients with 131I+ lymph nodes on initial PTS, especially those with N0 or N1a stage, lower sTg level, smaller LNM size, ≤2 residual/recurrent LNMs, negative ultrasound features and no 131I- LNM, remain stable after one cycle of 131I therapy and do not need repeated therapy.
摘要：
■分化型甲状腺癌（DTC）手术后经常发现残留/复发淋巴结转移（LNM）。这项研究旨在调查在初次治疗后扫描（PTS）时患有DTC放射性碘（131I）淋巴结的患者是否需要重复131I治疗。
■从2013年6月至2022年8月，回顾性纳入接受至少两个周期131I治疗的初次PTS上有131I+淋巴结的DTC患者。根据2015年美国甲状腺协会（ATA）指南，根据他们对初始131I治疗的反应，将他们分为完全反应（CR）组和不完全反应（IR）组。
■共有170例DTC患者在初始PTS中有131I+淋巴结；42/170（24.7％）患者被分为CR组，128/170（75.9％）根据他们对初始131I治疗的反应被分为IR组。42例CR患者在随后的随访中均无疾病进展，37/170（21.8％）IR患者在重复治疗后有所改善。单因素分析显示N阶段(P=0.002),最初131I治疗前的刺激甲状腺球蛋白（sTg）水平（P<0.001），LNM大小（P<0.001），总残留/复发LNM数(P=0.021)，放射性碘-nonavid（131I-）LNM（P=0.002）和超声特征（P<0.001）与初始治疗反应相关。在多变量分析中，sTg水平（OR=1.186，P<0.001）和LNM大小（OR=1.533，P=0.004）是初始131I治疗后IR的独立危险因素。用于预测初始131I治疗后的治疗反应的最佳sTg水平和LNM尺寸截止值为18.2µg/l和5mm。
■这项研究表明，大约四分之一的患者在最初的PTS上有131I+淋巴结，尤其是那些带有N0或N1a级的，较低的sTg水平，较小的LNM尺寸，≤2个残留/复发LNM，负超声特征和无131I-LNM，131I治疗一个周期后保持稳定，不需要重复治疗。
■从2013年6月至2022年8月，回顾性纳入接受至少两个周期131I治疗的初次PTS上有131I+淋巴结的DTC患者。根据2015年美国甲状腺协会（ATA）指南，根据他们对初始131I治疗的反应，将他们分为完全反应（CR）组和不完全反应（IR）组。
■共有170例DTC患者在初始PTS中有131I+淋巴结；42/170（24.7％）患者被分为CR组，128/170（75.9％）根据他们对初始131I治疗的反应被分为IR组。42例CR患者在随后的随访中均无疾病进展，37/170（21.8％）IR患者在重复治疗后有所改善。单因素分析显示N阶段(P=0.002),最初131I治疗前的刺激甲状腺球蛋白（sTg）水平（P<0.001），LNM大小（P<0.001），总残留/复发LNM数(P=0.021)，放射性碘-nonavid（131I-）LNM（P=0.002）和超声特征（P<0.001）与初始治疗反应相关。在多变量分析中，sTg水平（OR=1.186，P<0.001）和LNM大小（OR=1.533，P=0.004）是初始131I治疗后IR的独立危险因素。用于预测初始131I治疗后的治疗反应的最佳sTg水平和LNM尺寸截止值为18.2µg/l和5mm。
■这项研究表明，大约四分之一的患者在最初的PTS上有131I+淋巴结，尤其是那些带有N0或N1a级的，较低的sTg水平，较小的LNM尺寸，≤2个残留/复发LNM，负超声特征和无131I-LNM，131I治疗一个周期后保持稳定，不需要重复治疗。
