Elevated serum thyroglobulin levels at the time of ablative radioactive iodine therapy indicate a worse prognosis in thyroid cancer: an Australian retrospective cohort study

Matthews, Timothy James; Chua, Elizabeth L.; Gargya, Ash; Clark, Jonathan R.; Gao, Kan; Elliott, Michael

doi:10.1017/s0022215116008331

Cited by 15 publications

(14 citation statements)

References 17 publications

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“…Matthews et al . described patients with a thyroglobulin level of 27.5 μg/l or higher with reduced disease-free survival [18]. Similarly, Podnos et al .…”

Section: Discussionmentioning

confidence: 99%

Age, thyroglobulin levels and ATA risk stratification predict 10-year survival rate of differentiated thyroid cancer patients

et al. 2019

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Introduction Differentiated thyroid cancer (DTC) is the most common of endocrine cancers. Many studies have focused on recurrence-free survival of DTC patients, however, few studies have addressed overall survival rates. Given its very good prognosis, estimating overall or long-term survival in patients with DTC seems rational. So far, neither the impact of pre- and post-ablation thyroglobulin, nor that of initial American Thyroid Association (ATA) risk stratification on long-term disease-specific survival, have been sufficiently studied. Objective The aim of this study was to determine the factors that influence long-term disease-specific survival and thyroglobulin levels in patients with DTC who have been previously treated with thyroidectomy and radioactive iodine (RAI) remnant ablation. Patients and methods This observational retrospective study included 1093 patients who were treated for DTC between 1995 and 2010 and are still monitored in our tertiary center. Only patients who needed RAI ablation after thyroidectomy were included in this study. Patients who were treated with RAI following rhTSH stimulation, patients who presented positive anti-thyroglobulin antibodies, and patients who had micro-cancers were excluded. Pre-ablation stimulated thyroglobulin (Pre-ablation sTg) was measured after thyroid hormone withdrawal (THW), just before RAI. Results According to ATA standards, 29 patients (2.7%) were classified as high-risk patients. Initial ATA high-recurrence risk rating (HR 21.9; 95% CI: 8.5-56.3), age>55 years (HR 23.8; 95%-CI: 7.5-75.3) and pre-ablation sTg≥30 μg/l (HR 8.4; 95% CI: 4.6-15.3) significantly impacted ten-year survival. Moreover, age over 45 years, ATA moderate-risk and follicular DTC were also significant. Ten-year survival was lower in ATA high-risk patients (51% vs 95% and 93% for the low and intermediate risk; p<10 -7 ), patients older than 55 years (82% vs 98%; p<10 -7 ), and in patients with pre-ablation sTg≥30 (78% vs 95%; p<10 -7 ). Three rates of long-term survival were distinguished: excellent (survival rate of 99% in patients<55 years with pre-ablation sTg <30μg/l) representing 59% of the cohort, moderate (survival rate of 94.5% in patients <55 years with pre-ablation sTg ≥30μg/l or ≥55 years with pre-ablation sTg <30 μg/l) representing 38% of the cohort, and low (survival rate of 49% in patients ≥55 years with pre-ablation sTg ≥30μg/l) representing 3% of the cohort. Conclusion Initial ATA high-risk classification, age over 55 years old and pre-ablation sTg ≥30 μg/l are the main negative factors that influence the ten-year survival in DTC. We suggest three categories of overall survival rates. Patients older than 55 years with pre-ablation sTg ≥30 μg/l have the worst survival rate.

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“…Matthews et al . described patients with a thyroglobulin level of 27.5 μg/l or higher with reduced disease-free survival [18]. Similarly, Podnos et al .…”

Section: Discussionmentioning

confidence: 99%

Age, thyroglobulin levels and ATA risk stratification predict 10-year survival rate of differentiated thyroid cancer patients

et al. 2019

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“…A meta-analysis by Webb et al [5] including data from nearly 4,000 patients showed an overall NPV of pre-RAI sTg < 10 µg/L of 94.2% for predicting disease-free status. In a more recent Australian study by Matthews et al [4], a significant difference in prognosis was found in patients with elevated Tg values (> 27.5 µg/L) at the time of RAI administration. Conversely, our study could not confirm the role of serum pre-Tg as a risk factor for disease progression in patients considered to have persistent structural disease after initial therapy (group 2).…”

Section: Discussionmentioning

confidence: 89%

“…An accurate initial risk appraisal is therefore crucial in these patients because it not only defines the need for postoperative RAI administration, but also allows formulation of an appropriate surveillance strategy. Features known to correlate with poorer prognosis are higher American Joint Committee on Cancer (AJCC) stage, advanced age, male sex, extrathyroidal extension, and certain histological subtypes [4], but many authors have also researched serum Tg measured just before RAI administration as a marker for predicting persistent or recurrent disease, with reported cut-off values ranging from 1.0 to 10.0 µg/L [5][6][7][8]. Due to its high negative predictive value (NPV) in this setting, preablation Tg has been suggested to be a useful and inexpensive tool for risk evaluation early on during and after initial treatment.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Stimulated Thyroglobulin Levels at the Time of Radioiodine Administration in Differentiated Thyroid Cancer

et al. 2018

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Objective: The prognostic value of stimulated thyroglobulin (sTg) and Tg-related parameters prior to and immediately after radioactive iodine (RAI) administration was assessed in a cohort of patients presenting with differentiated thyroid cancer (DTC) as a predictor of recurrent or progressive structural disease. Methods: Clinical records of 180 DTC patients were retrospectively reviewed, and serum TSH, Tg, and Tg antibodies were recorded just before RAI administration (pre-) and at the time of whole body scanning (post-). Based on the results of initial staging and RAI scintigraphy, patients were divided into two groups: those who were considered to be structurally disease-free after thyroidectomy and RAI (group 1) and those who were not (group 2). Univariate analyses were performed for pre-Tg, ratioTg (post-Tg/pre-Tg), and other clinical and pathological markers for long-term outcome, as well as separate bivariate analyses focusing on pre-Tg to correct for possible confounders. Different pre-Tg cut-off values for predicting structural disease recurrence were assessed in a subgroup of patients in group 1 prepared with thyroid hormone withdrawal. Results: In group 1, (n = 166) male gender, higher T-stage and both Tg-related parameters proved to be significant risk factors for structural disease relapse. Of all candidate variables, only higher T-stage served to predict progressive structural disease in group 2 (n = 14). Subgroup analysis showed a negative predictive value of 91.67% for pre-Tg < 10 µg/L. Conclusion: The sTg value at the time of RAI administration may be helpful in predicting structural disease recurrence in patients with DTC.

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“…Postoperative serum thyroglobulin levels can be a predictor of persistent disease after surgery, according to the ATA's guidelines, but the optimal cutoff value to guide decisions in terms of appropriate radioiodine dose has not yet been well established. Several studies (11)(12)(13)(14)(15)(22)(23)(24)(25)(26)(30)(31)(32)(33)(34)(35)(36)(37) have demonstrated the clinical use of the serum thyroglobulin measurement (either TSH stimulated or non-stimulated) as a tool to aid in initial risk stratification to guide treatment and predict prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, some studies associate greater ps-Tg values with worse prognosis in DTC patients. In one prospective study, a ps-Tg threshold of >5 ng/mL was considered appropriate to indicate RIT ( 31 ). Two other studies ( 34 , 35 ) reported that elevated Tg levels (>5-6 ng/mL) may be a predictor of failing ablation, after administration of RIT doses of 30 mCi ( 34 ) and 100 mCi ( 35 ), suggesting that higher Tg levels could be correlated with a more aggressive tumor profile.…”

Section: Discussionmentioning

confidence: 99%

A cutoff thyroglobulin value suggestive of distant metastases in differentiated thyroid cancer patients

Couto¹,

Almeida²,

Trindade³

et al. 2020

Braz J Med Biol Res

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Serum thyroglobulin is used as part of the early postoperative assessment of differentiated thyroid cancer (DTC) since there is a clear relationship between an increased risk of recurrence and persistent disease after initial treatment and high postoperative stimulated thyroglobulin (ps-Tg) values. Thus, although ps-Tg above 10-30 ng/mL is considered an independent predictor of worse prognosis, the value that is associated with distant metastases is not defined. Thus, this was our objective. We selected 655 DTC patients from a nuclear medicine department database (Irmandade Santa Casa de Misericórdia de São Paulo, Brazil). All patients had received total thyroidectomy and radioactive iodine (RAI) therapy and had ps-Tg values higher than 10 ng/mL with negative anti-thyroglobulin antibodies. Then, we selected patients who presented post-therapy whole-body scan with pulmonary and/or bone uptake but with no mediastinum or cervical uptake. Patients with negative findings on functional imaging or any doubt on lung/bone uptake were submitted to additional exams to exclude another non-thyroid tumor. Of the 655 patients, 14.3% had pulmonary and 4.4% bone metastases. There was a significant difference in ps-Tg levels between patients with and without metastases (Po0.001). The cutoff value of ps-Tg was 117.5 ng/mL (sensitivity: 70.2%; specificity: 71.7%) for those with lung metastasis, and 150.5 ng/mL (sensitivity: 79.3%; specificity: 85%) for those with bone metastasis. The cutoff value for patients with eitherpulmonary or bone metastasis was 117.5 ng/mL (sensitivity: 70.2%; specificity: 83.7%). Our findings demonstrated that ps-Tg could predict distant metastasis in DTC patients. We identified a cutoff of 117.5 ng/mL with a high negative predictive value of 93.7%.

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Elevated serum thyroglobulin levels at the time of ablative radioactive iodine therapy indicate a worse prognosis in thyroid cancer: an Australian retrospective cohort study

Abstract: An elevated thyroglobulin level of 27.5 µg/l or higher at the time of ablative radioactive iodine therapy is a prognostic indicator for macroscopic disease recurrence in well-differentiated thyroid carcinoma.

Cited by 15 publications

References 17 publications

Age, thyroglobulin levels and ATA risk stratification predict 10-year survival rate of differentiated thyroid cancer patients

Age, thyroglobulin levels and ATA risk stratification predict 10-year survival rate of differentiated thyroid cancer patients

Prognostic Value of Stimulated Thyroglobulin Levels at the Time of Radioiodine Administration in Differentiated Thyroid Cancer

A cutoff thyroglobulin value suggestive of distant metastases in differentiated thyroid cancer patients

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