Clinical outcomes and associated factors of radioiodine-131 treatment in differentiated thyroid cancer with cervical lymph node metastasis

Cao, Chung‐Jie; Dou, Cheng-Yun; Lian, Jiayan; Luan, Zhao-sheng; Zhou, Wen; Xie, Wenlin; Chen, Li; Zhou, Kehua; Li, Hong

doi:10.3892/ol.2018.8270

Cited by 9 publications

(12 citation statements)

References 31 publications

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Section: Discussionsupporting

confidence: 93%

“…Our finding is in accordance with another recent report which demonstrated limited benefit of further RAI administration in DTC patients with biochemical or structural incomplete response to initial therapy. 24 Given that additional lymph node dissection is not always curative and/or the effectiveness of RAI on lymph node disease is debated, 25 20% change from the previous anti-Tg titre) occurs during follow-up, monitoring with further imaging methods for the detection of possible residual structural disease is mandatory. 14,27 To overcome this problem, sensitive biomarkers, not influenced by anti-Tg antibodies, such as Tg measurement with peptide immunoaffinity enrichment in concert with liquid chromatography-tandem mass spectrometry 28,29 or thyroid cancer-specific mRNA or DNA transcripts from circulating blood, have also been suggested.…”

Section: Discussionmentioning

confidence: 99%

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Histology is more ιmportant than persistent anti‐Tg antibodies for progression of differentiated thyroid cancer

Karapanou

Saltiki

Simeakis

et al. 2021

Clinical Endocrinology

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Context Anti‐thyroglobulin antibodies (anti‐Tg), present in 20%‐25% of differentiated thyroid cancer (DTC) patients, interfere with thyroglobulin measurements posing a challenge in the follow‐up. Objectives The aim of this study was to identify clinical‐histological factors that may affect anti‐Tg persistence and disease outcome in DTC with positive anti‐Tg. Methods We retrospectively studied 234 DTC patients, with positive anti‐Tg at diagnosis (females: 82.1%, age at diagnosis: 46.0 ± 14.4 yrs, median follow‐up: 5 yrs (1.5‐32 yrs). 221/234 (94.4%) received radioiodine (RAI) ablation. Patients were divided into two subgroups: those whose anti‐Tg became undetectable (anti‐Tg‐NEG) and those whose anti‐Tg remained positive (anti‐Tg‐POS) at the end of the follow‐up period. Results Anti‐Tg‐POS patients (n = 80, 34.2%) compared to anti‐Tg‐NEG (n = 154, 65.8%) had more frequently lymph node infiltration (36.3% vs 20.1%, P = .01), extrathyroidal extension (ETE, 35.0% vs 22.1%, P = .04), poorly differentiated DTC and increased tumour size (P ≤ .004). They received higher total RAI dose (P < .001). In most cases, additional RAI administration and/or additional surgeries did not lead to anti‐Tg elimination. These had more frequently structural disease persistence/progression compared to anti‐Tg‐NEG (remission: 78.8% vs 95.5%, persistence: 13.8% vs 3.9%, progression: 7.5% vs 0.6%, P < .001). In Kaplan‐Meier analysis, the probability of disease progression was higher in anti‐Tg‐POS. In Cox proportional hazard analysis, the predictors of disease progression were size (P = .002) and ETE (P = .006). Conclusions Worse histological features are more frequent in patients with anti‐Tg persistence during follow‐up. Further additional RAI administration and/or surgeries do not affect anti‐Tg elimination in most cases. Anti‐Tg persistence correlates with structural persistence although tumour size and extrathyroidal extension are the main predictors of disease progression.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Histology is more ιmportant than persistent anti‐Tg antibodies for progression of differentiated thyroid cancer

Karapanou

Saltiki

Simeakis

et al. 2021

Clinical Endocrinology

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“…The effect of RAI therapy on the outcomes of patients with DTC with LNM is unclear. Published studies demonstrated a response rate (complete or partial responses) of more than 70%, 13‐15 which is higher than the one obtained in our series, in which patients showed a response rate to RAI of 30% (n = 7) and maintained stable disease in 35% (n = 8). It is important to note that in the group of RAI treatment, most patients performed only one RAI therapy.…”

Section: Discussioncontrasting

confidence: 76%

Clinical outcomes of a conservative approach in cervical lymph node metastases of thyroid cancer

Maciel¹,

Donato²,

Simões³

et al. 2020

Clinical Endocrinology

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Context Lymph node metastases (LNM) can be present in 35% of patients with differentiated thyroid cancer (DTC), and the management of persistent/recurrent nodal disease has been controversial. Watchful waiting may be a reasonable approach in selected patients, but uncertainty about clinical outcomes remains a concern. Objective To investigate the outcomes of patients with DTC with recurrent/persistent confirmed LNM under surveillance. Methods Patients with LNM from DTC were selected from databases of needle washout thyroglobulin measurements and fine‐needle aspiration biopsies performed in our institution. Patients with confirmed metastases, in whom active surveillance was initially proposed, were selected. Main clinical outcomes were analysed. Results We found 89 patients with LNM under surveillance. Classic papillary was the most frequent variant (44%). During a median follow‐up of 3 (0.5‐17.2) years, different treatments were needed in 35 (39.3%) patients: radioactive iodine (RAI) in 23 (25.8%), surgery in 9 (10.1%) and radiotherapy (RT) in 3 (3.4%). From those submitted initially to RAI, progression of disease was observed in 8 patients, 4 requiring other treatment modalities: surgery (n = 2), RT (n = 1) and RAI (n = 1). The remaining 54 (60.7%) patients maintained surveillance. In this group, progression of disease was observed in 26 (48.1%), due to increase in the number and/or volume of metastases, but further treatments were not required. Conclusion In a group of patients with cervical LNM under active surveillance, only 16.9% (n = 15) required invasive intervention (surgery or RT).

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“…This is in contrast to a similar (but not the same) type of study which demonstrated increased rates of successful RAI on patients who waited 1 month or less between surgery and RAI. [ 10 ]…”

Section: Resultsmentioning

confidence: 99%

Clinical predictors of I-131 therapy failure in differentiated thyroid cancer by machine learning: A single-center experience

Lubin

Tsetse

Khorasani³

et al. 2021

World J Nucl Med

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Well-differentiated thyroid carcinoma is predominantly a slow-growing malignancy, amendable to treatment, and has an excellent prognosis following thyroidectomy and radioiodine (RAI) therapy. However, patients who fail the initial RAI treatment attempt may require repeated RAI or other treatments and with this, comes an associated impact on patient quality of life. Therefore, the anticipation of patients in whom there is a higher risk of RAI failure may help in patient risk stratification and subsequent management. We conducted a retrospective review to determine the factors associated with initial RAI therapy failure in well-differentiated thyroid cancer patients. Using scikit-learn from Python, we implemented a machine-learning algorithm to determine the clinical patient factors associated with a higher likelihood of treatment resistance. We found that clinical factors such as tumor focality ( P = 0.026) and lymph node invasion at surgical resection ( P = 0.0135) were significantly associated with initial treatment failure following RAI. Elevated serum thyroglobulin (Tg) and Tg antibody levels following surgery but before RAI were also associated with treatment resistance ( P < 0.0001 and P = 0.011 respectively). Less expected factors such as decreased time from surgery to RAI were also associated with treatment failure, however not to a statistically significant degree ( P > 0.064). Clinical outcomes following RAI can be stratified by identifying factors that are associated with initial treatment failure. These findings can help restratify patients for RAI treatment and change patient management in certain cases. Such stratification will ultimately help to optimize successful treatment outcomes and improve patient quality of life.

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Clinical outcomes and associated factors of radioiodine-131 treatment in differentiated thyroid cancer with cervical lymph node metastasis

Cited by 9 publications

References 31 publications

Histology is more ιmportant than persistent anti‐Tg antibodies for progression of differentiated thyroid cancer

Histology is more ιmportant than persistent anti‐Tg antibodies for progression of differentiated thyroid cancer

Clinical outcomes of a conservative approach in cervical lymph node metastases of thyroid cancer

Clinical predictors of I-131 therapy failure in differentiated thyroid cancer by machine learning: A single-center experience

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