Is Postoperative Adjuvant Radioactive Iodine Ablation Therapy Always Necessary for Intermediate-Risk Papillary Thyroid Cancer Patients With Central Neck Metastasis?

Han, Kyujin; Noh, Hae Min; Jeong, Ha Min; Lim, Young Chang

doi:10.1245/s10434-021-10164-1

Cited by 10 publications

(16 citation statements)

References 32 publications

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“…However, the 104 patients and the median follow-up of 53 months may be limited in the evaluation of the recurrence risk of PTC (13). A recent study showed that the recurrence-free survival curve of the intermediate-risk PTC patients who received postoperative RAI therapy (n = 208) did not differ significantly from that of the patients who did not receive it (n = 141), especially for patients with negative extranodal spread and low number (<5) of metastatic lymph nodes (14). However, they did not focus on OS of PTC patients.…”

Section: Discussionmentioning

confidence: 99%

Radioactive iodine in low- to intermediate-risk papillary thyroid cancer

Zhao

Yang

2022

Front. Endocrinol.

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It remains controversial whether papillary thyroid cancer (PTC) patients with low- to intermediate-risk disease should receive radioactive iodine (RAI) after total thyroidectomy (TT). We aim to identify those who might benefit from RAI treatment in PTC patients with cervical nodal metastasis after TT. Patients were divided into TT and TT+RAI groups from the Surveillance, Epidemiology, and End Results (SEER) database (2004–2018). Overall survival (OS) and cancer-specific survival (CSS) were compared, and propensity score matching (PSM) was performed between groups. A total of 15,179 patients were enrolled, including 3,387 (22.3%) who underwent TT and 11,792 (77.7%) who received TT+RAI. The following characteristics were more likely to present in the TT+RAI group: multifocality, capsular extension, T3, N1b, and more metastatic cervical lymph nodes. RAI was associated with better OS in low- to intermediate-risk PTC patients in the multivariate Cox regression model. The subgroup analysis showed that RAI predicted better OS in patients ≥55 years, American Joint Committee on Cancer (AJCC) stage II, and capsular extension with a hazard ratio (HR) (95% CI) of 0.57 (0.45–0.72), 0.57 (0.45–0.72), and 0.68 (0.51–0.91), respectively. However, RAI failed to improve the prognoses of patients with age <55 years, AJCC stage I, PTC ≤1 cm, and capsular invasion. In the PSM cohort with 3,385 paired patients, TT+RAI treatment predicted better OS compared with TT alone. In addition, TT+RAI predicted better OS in patients with metastatic cervical lymph nodes ≥2, multifocality, extracapsular extension, and American Thyroid Association (ATA) intermediate risk. In conclusion, RAI was associated with better OS in low- to intermediate-risk PTC patients with age ≥55 years, multifocality, extrathyroidal extension, and ATA intermediate risk. However, the survival benefit from RAI may be limited in patients with AJCC stage I, PTC ≤1 cm, unifocality, capsular invasion, and ATA low-risk diseases; these patients even showed pathological cervical lymph node metastasis.

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Section: Discussionmentioning

confidence: 99%

Radioactive iodine in low- to intermediate-risk papillary thyroid cancer

Zhao

Yang

2022

Front. Endocrinol.

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“…After a thorough review of titles/abstracts and the removal of duplicate records, a total of 46 full-text articles were assessed for eligibility. Eleven articles 6,[12][13][14][19][20][21][22][23][24][25] comprising a total of 56,266 patients were finally included (Figure 1). All studies were retrospective in design.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Eight [12][13][14]20,[22][23][24][25] were single-centre studies and the remaining three 6,19,21 were registry-based studies. Four studies were from Korea, 12,13,20,25 three from China, 6,14,23 two from the US, 19,21 and one each from India 22 and Japan. 24 All studies included patients with intermediate-risk PTC.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Of the 11 included studies, eight evaluated the impact of RAI therapy on structural recurrence rates using univariate binary logistic regression analysis. 12,14,19,20,[22][23][24][25] Two studies assessed the impact of RAI therapy on RFS using multivariate analysis. 13,14 The effect of RAI therapy on OS was evaluated in two studies using multivariate analysis.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The rates of structural recurrence ranged from 0.74% to 16.4% (for the overall cohort) in the evaluable articles. We extracted univariate ORs from eight articles 12,14,19,20,[22][23][24][25] consisting of 2992 patients (RAI -2417 and NOI -575) to assess the impact of RAI therapy on structural recurrence. The estimated pooled OR was 0.73 (95% CI, 0.29-1.87; p = .52), and substantial statistical heterogeneity was observed (I 2 = 75%, p < .001) (Figure 2).…”

Section: Pooled or For Structural Recurrencementioning

confidence: 99%

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Impact of radioiodine therapy on recurrence and survival outcomes in intermediate‐risk papillary thyroid carcinoma —A systematic review and meta‐analysis

Chandekar,

Satapathy,

Bal

2023

Clinical Endocrinology

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ObjectiveThe utility of radioiodine (RAI) therapy in intermediate‐risk papillary thyroid carcinoma (PTC) remains a topic of ongoing discussion. This systematic review and meta‐analysis aimed to consolidate existing evidence on the impact of postoperative RAI therapy on recurrence and survival outcomes in intermediate‐risk PTC.MethodsA literature search was performed using relevant keywords in PubMed, Scopus, and EMBASE. Articles from January 2008 to March 2023 were included. Odds ratios (ORs) and hazard ratios (HRs) were extracted from the individual articles, and pooled estimates were generated using meta‐analysis.ResultsEleven articles comprising 56,266 intermediate‐risk PTC patients were included. 41,530 (73.8%) patients underwent postoperative RAI therapy, while 14,736 (26.2%) patients were kept on no‐RAI (NOI) follow‐up. No significant reduction in rates of structural disease recurrence was noted with RAI therapy in comparison to NOI follow‐up (pooled univariate OR, 0.73, 95% confidence interval [CI], 0.29–1.87, I2 = 75%). RAI therapy was not a significant predictor of better recurrence‐free survival (pooled multivariate HR, 0.21; 95% CI, 0.01–3.74, I2 = 94%). Interestingly, RAI therapy was associated with an overall survival benefit compared to NOI follow‐up (pooled multivariate HR, 0.63; 95% CI, 0.48–0.82, I2 = 79%).ConclusionsThis meta‐analysis did not establish a conclusive benefit of RAI therapy in preventing structural disease recurrence or improving recurrence‐free survival in intermediate‐risk PTC. However, these results need to be interpreted with caution owing to significant heterogeneity in the existing literature. A prospective, randomised clinical trial is the need of the hour to better understand the effect of RAI therapy on long‐term outcomes.

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