Abstract：
BACKGROUND: This meta-analysis and systematic review aimed to evaluate the therapeutic efficacy and advantages associated with the use of recombinant human thyroid-stimulating hormone (rhTSH) for radioactive iodine (RAI) therapy in patients with intermediate- to high-risk differentiated thyroid cancer.
METHODS: MEDLINE, EMBASE, and Cochrane databases were searched to identify relevant articles reporting clinical outcomes of rhTSH compared with thyroid hormone withdrawal (THW) in patients with intermediate- to high-risk differentiated thyroid cancer published between January 2012 and June 2023. Meta-analyses were performed (PROSPERO registration number: CRD42022340915) to assess the success rate of radioiodine remnant ablation (RRA) in patients with intermediate to high risk and determine the disease control rate among patients with distant metastases, evaluated using the RECIST criteria.
RESULTS: Thirteen studies involving 1858 patients were included in the meta-analysis. Pooled analyses revealed significantly higher overall RRA success rate in the rhTSH group compared with the THW group, with a risk ratio (RR) of 1.12 (95% confidence interval [CI], 1.01-1.25). However, in the subgroup analysis of high-risk patients, pooled analyses showed no significant differences in RRA success rate between the rhTSH group compared with the THW group with a pooled RR of 1.05 (95% CI, 0.88-1.24). In patients with distant metastases, there were no significant differences in the disease control rate between groups, with a pooled RR of 1.06 (95% CI, 0.78-1.44).
CONCLUSIONS: rhTSH for RAI therapy is a practical option for RAI therapy in patients with intermediate- to high-risk thyroid cancer, including those with distant metastases.
METHODS: MEDLINE, EMBASE, and Cochrane databases were searched to identify relevant articles reporting clinical outcomes of rhTSH compared with thyroid hormone withdrawal (THW) in patients with intermediate- to high-risk differentiated thyroid cancer published between January 2012 and June 2023. Meta-analyses were performed (PROSPERO registration number: CRD42022340915) to assess the success rate of radioiodine remnant ablation (RRA) in patients with intermediate to high risk and determine the disease control rate among patients with distant metastases, evaluated using the RECIST criteria.
RESULTS: Thirteen studies involving 1858 patients were included in the meta-analysis. Pooled analyses revealed significantly higher overall RRA success rate in the rhTSH group compared with the THW group, with a risk ratio (RR) of 1.12 (95% confidence interval [CI], 1.01-1.25). However, in the subgroup analysis of high-risk patients, pooled analyses showed no significant differences in RRA success rate between the rhTSH group compared with the THW group with a pooled RR of 1.05 (95% CI, 0.88-1.24). In patients with distant metastases, there were no significant differences in the disease control rate between groups, with a pooled RR of 1.06 (95% CI, 0.78-1.44).
CONCLUSIONS: rhTSH for RAI therapy is a practical option for RAI therapy in patients with intermediate- to high-risk thyroid cancer, including those with distant metastases.
摘要：
背景：这项荟萃分析和系统评价旨在评估使用重组人促甲状腺激素（rhTSH）用于放射性碘（RAI）治疗中高风险分化型甲状腺癌患者的疗效和优势。
方法：MEDLINE，EMBASE,本研究检索了Cochrane数据库,以确定2012年1月至2023年6月期间发表的报告rhTSH与甲状腺激素停药(THW)在中危分化型甲状腺癌患者中的临床结局比较的相关文章.进行荟萃分析（PROSPERO登记号：CRD42022340915），以评估中高风险患者的放射性碘残留消融（RRA）的成功率，并确定远处转移患者的疾病控制率。使用RECIST标准进行评估。
结果：在荟萃分析中纳入了涉及1858例患者的13项研究。汇总分析显示，rhTSH组的整体RRA成功率明显高于THW组，风险比(RR)为1.12(95%置信区间[CI]，1.01-1.25）。然而,在高危患者的亚组分析中，汇总分析显示,rhTSH组与THW组相比,RRA成功率无显著差异,汇总RR为1.05(95%CI,0.88~1.24).在远处转移的患者中，组间疾病控制率无显著差异,合并RR为1.06（95%CI，0.78-1.44）。
结论：rhTSH用于RAI治疗是中高危甲状腺癌患者RAI治疗的一种实用选择，包括那些有远处转移的。
方法：MEDLINE，EMBASE,本研究检索了Cochrane数据库,以确定2012年1月至2023年6月期间发表的报告rhTSH与甲状腺激素停药(THW)在中危分化型甲状腺癌患者中的临床结局比较的相关文章.进行荟萃分析（PROSPERO登记号：CRD42022340915），以评估中高风险患者的放射性碘残留消融（RRA）的成功率，并确定远处转移患者的疾病控制率。使用RECIST标准进行评估。
结果：在荟萃分析中纳入了涉及1858例患者的13项研究。汇总分析显示，rhTSH组的整体RRA成功率明显高于THW组，风险比(RR)为1.12(95%置信区间[CI]，1.01-1.25）。然而,在高危患者的亚组分析中，汇总分析显示,rhTSH组与THW组相比,RRA成功率无显著差异,汇总RR为1.05(95%CI,0.88~1.24).在远处转移的患者中，组间疾病控制率无显著差异,合并RR为1.06（95%CI，0.78-1.44）。
结论：rhTSH用于RAI治疗是中高危甲状腺癌患者RAI治疗的一种实用选择，包括那些有远处转移的。
