Abstract：
BACKGROUND: The 2015 American Thyroid Association (ATA) guidelines proposed the use of the ATA Risk Stratification System and American Joint Committee on Cancer Tumor-Node-Metastasis (AJCC/TNM) Staging System for postoperative radioiodine decision-making. However, the management of patients with intermediate-risk differentiated thyroid carcinoma (DTC) is not well defined. In this study, we aimed to evaluate the therapeutic efficacy of radioactive iodine therapy (RAIT) among various subgroups of patients with intermediate-risk DTC after surgery.
METHODS: This was a retrospective study based on the Surveillance, Epidemiology, and End Results (SEER) database (2010-2015). The DTC patients with intermediate risk of recurrence were divided into two groups (treated or not treated with radioactive iodine (RAI)). As the treatment was not randomly assigned, stabilized inverse probability treatment weighting (sIPTW) was used to reduce selection bias. We used the Kaplan-Meier method and log-rank test to analyze overall survival (OS) and cancer-specific survival (CSS).
RESULTS: Kaplan-Meier analysis after sIPTW found a significant difference in OS and CSS between no RAIT and RAIT (log-rank test, P < 0.0001; P = 0.0019, respectively). The Kaplan-Meier curves of CSS in age cutoff of 55 years showed a significant association between no RAIT and RAIT (log-rank test, P = 0.0045). Univariate and multivariate Cox regression showed RAIT was associated with a reduced risk of mortality compared with no RAIT (hazard ratio [HR] 0.59, 95% confidence interval [95% CI 0.44-0.80]). Age (≥ 55) years showed a worse CSS regardless of whether or not a patient was treated or not treated with RAI ([HR] 8.91, 95% confidence interval [95% CI 6.19-12.84]).
CONCLUSIONS: RAIT improves OS and CSS in patients with intermediate-risk DTC after surgery. 55 years is a more appropriate prognostic age cutoff for the relevant classification systems and is a crucial consideration in RAI decision-making. Therefore, we need individualized treatment plans.
METHODS: This was a retrospective study based on the Surveillance, Epidemiology, and End Results (SEER) database (2010-2015). The DTC patients with intermediate risk of recurrence were divided into two groups (treated or not treated with radioactive iodine (RAI)). As the treatment was not randomly assigned, stabilized inverse probability treatment weighting (sIPTW) was used to reduce selection bias. We used the Kaplan-Meier method and log-rank test to analyze overall survival (OS) and cancer-specific survival (CSS).
RESULTS: Kaplan-Meier analysis after sIPTW found a significant difference in OS and CSS between no RAIT and RAIT (log-rank test, P < 0.0001; P = 0.0019, respectively). The Kaplan-Meier curves of CSS in age cutoff of 55 years showed a significant association between no RAIT and RAIT (log-rank test, P = 0.0045). Univariate and multivariate Cox regression showed RAIT was associated with a reduced risk of mortality compared with no RAIT (hazard ratio [HR] 0.59, 95% confidence interval [95% CI 0.44-0.80]). Age (≥ 55) years showed a worse CSS regardless of whether or not a patient was treated or not treated with RAI ([HR] 8.91, 95% confidence interval [95% CI 6.19-12.84]).
CONCLUSIONS: RAIT improves OS and CSS in patients with intermediate-risk DTC after surgery. 55 years is a more appropriate prognostic age cutoff for the relevant classification systems and is a crucial consideration in RAI decision-making. Therefore, we need individualized treatment plans.
摘要：
背景：2015年美国甲状腺协会（ATA）指南建议使用ATA风险分层系统和美国癌症肿瘤淋巴结转移联合委员会（AJCC/TNM）分期系统进行术后放射性碘决策。然而,中危分化型甲状腺癌(DTC)患者的治疗方法尚不明确.在这项研究中,我们旨在评估放射性碘治疗(RAIT)在手术后中危DTC患者的不同亚组中的疗效.
方法：这是一项基于监测的回顾性研究，流行病学,和最终结果(SEER)数据库(2010-2015年)。将具有中等复发风险的DTC患者分为两组（接受或不接受放射性碘（RAI）治疗）。由于治疗不是随机分配的，稳定的逆概率治疗加权(sIPTW)用于减少选择偏差。我们使用Kaplan-Meier方法和对数秩检验来分析总生存期（OS）和癌症特异性生存期（CSS）。
结果：SIPTW后的Kaplan-Meier分析发现，无RAIT和RAIT之间的OS和CSS存在显着差异（对数秩检验，P<0.0001；P=0.0019）。CSS的Kaplan-Meier曲线在55岁的截止年龄中显示出无RAIT和RAIT之间的显着关联（对数秩检验，P=0.0045)。单变量和多变量Cox回归显示，与无RAIT相比，RAIT与死亡率风险降低相关（风险比[HR]0.59，95%置信区间[95%CI0.44-0.80]）。无论患者是否接受RAI治疗（[HR]8.91，95％置信区间[95％CI6.19-12.84]），年龄（≥55）岁的CSS均较差。
结论：RAIT可改善手术后中危DTC患者的OS和CSS。55岁是相关分类系统的更合适的预后年龄界限，并且是RAI决策中的关键考虑因素。因此,我们需要个性化的治疗计划。
方法：这是一项基于监测的回顾性研究，流行病学,和最终结果(SEER)数据库(2010-2015年)。将具有中等复发风险的DTC患者分为两组（接受或不接受放射性碘（RAI）治疗）。由于治疗不是随机分配的，稳定的逆概率治疗加权(sIPTW)用于减少选择偏差。我们使用Kaplan-Meier方法和对数秩检验来分析总生存期（OS）和癌症特异性生存期（CSS）。
结果：SIPTW后的Kaplan-Meier分析发现，无RAIT和RAIT之间的OS和CSS存在显着差异（对数秩检验，P<0.0001；P=0.0019）。CSS的Kaplan-Meier曲线在55岁的截止年龄中显示出无RAIT和RAIT之间的显着关联（对数秩检验，P=0.0045)。单变量和多变量Cox回归显示，与无RAIT相比，RAIT与死亡率风险降低相关（风险比[HR]0.59，95%置信区间[95%CI0.44-0.80]）。无论患者是否接受RAI治疗（[HR]8.91，95％置信区间[95％CI6.19-12.84]），年龄（≥55）岁的CSS均较差。
结论：RAIT可改善手术后中危DTC患者的OS和CSS。55岁是相关分类系统的更合适的预后年龄界限，并且是RAI决策中的关键考虑因素。因此,我们需要个性化的治疗计划。
