Predictive Factors for RAI-Refractory Disease and Short Overall Survival in PDTC

Kersting, David; Seifert, Robert; Kessler, Lukas; Herrmann, Ken; Theurer, Sarah; Brandenburg, Tim; Dralle, Henning; Weber, Frank; Umutlu, Lale; Führer-Sakel, Dagmar; Görges, Rainer; Rischpler, Christoph; Weber, Manuel

doi:10.3390/cancers13071728

Cited by 14 publications

(31 citation statements)

References 29 publications

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“…Previously, age ≥55 has been reported to be correlated with RAIR. 16 In addition, patients younger than 45 years and older than 75 years had a significant difference in median overall survival (OS) after RAIR diagnosis. 20 Besides, other tumour characteristics and clinical presentation have been evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, early stratification of risk in developing RAIR is crucial for the clinical decision‐making of surgery extent, radioiodine‐avid strategy and alternative targeted molecular therapy planning. Clinicopathological features such as primary tumour size (≥4 cm) and extrathyroidal extension (ETE) were previously reported to be correlated with RAIR‐DTC 16 . Moreover, post‐Tg doubling time <1 year and 131 I whole body scan (WBS) have been considered as golden rules for RAIR 17 .…”

Section: Introductionmentioning

confidence: 99%

“…Clinicopathological features such as primary tumour size (≥4 cm) and extrathyroidal extension (ETE) were previously reported to be correlated with RAIR-DTC. 16 Moreover, post-Tg doubling time <1 year and 131 I whole body scan (WBS) have been considered as golden rules for RAIR. 17 However, up to now, the prognostic value of pre-Tg in predicting RAIR has not been investigated.…”

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confidence: 99%

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Markedly elevated serum preoperative thyroglobulin predicts radioiodine‐refractory thyroid cancer

Cheng

Zhu

et al. 2021

Eur J Clin Investigation

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Background Repeated radiotherapy brings limited benefits and significant side effects for differentiated thyroid cancer patients (DTC) with radioiodine refractory (RAIR). However, the prognostic role of preoperative thyroglobulin (pre‐Tg) in predicting RAIR is unclear. Methods In the present study, data were retrospectively reviewed from 5173 patients who underwent radiotherapy in the Jiangyuan Hospital from January 2006 to December 2020. Results A total of 1,102 patients with or without repeated radiotherapy were compared (repeated vs. single radiotherapy; n = 199 vs. n = 903). Pre‐Tg was significantly elevated in patients with repeated radiotherapy. After the classification of RAIR (non‐RAIR, n = 786 vs. RAIR, n = 90), elevated pre‐Tg was also correlated with RAIR after univariate and multivariate analyses. According to the receiver operating characteristic curve analysis, elevated pre‐Tg well predicted RAIR (AUC = 0.76, CI: 0.71–0.82, p < 0.0001). To control the selection bias, the propensity score matching was used. Pre‐Tg level was found to be an independent predictor of RAIR (p < 0.001, HR = 7.25, CI: 2.55–20.62). Conclusion Our results indicate that markedly elevated pre‐Tg level can be served as an independent predictor of RAIR‐DTC, which can guide a more precise treatment strategy and/or an active surveillance during surgery and follow‐ups.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Markedly elevated serum preoperative thyroglobulin predicts radioiodine‐refractory thyroid cancer

Cheng

Zhu

et al. 2021

Eur J Clin Investigation

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“…Basically, postoperative RAI treatment should be performed because in many cases at least part of the disease shows a significant RAI uptake, which will reduce the tumor burden. On the other hand, high metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in [ 18 F]FDG PET/CT are significantly associated with poor prognosis [ 87 ]. Figure 5 demonstrates an example of PDTC measured with [ 18 F]FDG.…”

Section: Poorly Differentiated Thyroid Cancermentioning

confidence: 99%

Molecular Imaging and Theragnostics of Thyroid Cancers

Giovanella

Deandreis

Vrachims³

et al. 2022

Cancers

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Molecular imaging plays an important role in the evaluation and management of different thyroid cancer histotypes. The existing risk stratification models can be refined, by incorporation of tumor-specific molecular markers that have theranostic power, to optimize patient-specific (individualized) treatment decisions. Molecular imaging with varying radioisotopes of iodine (i.e., 131I, 123I, 124I) is an indispensable component of dynamic and theragnostic risk stratification of differentiated carcinoma (DTC) while [18F]F-fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) helps in addressing disease aggressiveness, detects distant metastases, and risk-stratifies patients with radioiodine-refractory DTC, poorly differentiated and anaplastic thyroid cancers. For medullary thyroid cancer (MTC), a neuroendocrine tumor derived from thyroid C-cells, [18F]F-dihydroxyphenylalanine (6-[18F]FDOPA) PET/CT and/or [18F]FDG PET/CT can be used dependent on serum markers levels and kinetics. In addition to radioiodine therapy for DTC, some theragnostic approaches are promising for metastatic MTC as well. Moreover, new redifferentiation strategies are now available to restore uptake in radioiodine-refractory DTC while new theragnostic approaches showed promising preliminary results for advanced and aggressive forms of follicular-cell derived thyroid cancers (i.e., peptide receptor radiotherapy). In order to help clinicians put the role of molecular imaging into perspective, the appropriate role and emerging opportunities for molecular imaging and theragnostics in thyroid cancer are discussed in our present review.

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“…Over recent years, clinicopathological characteristics, as well as molecular features, have been recognized as meaningful indicators that could be utilized for RAIR prediction. And factors like older age, larger primary tumor size, extrathyroidal extension (ETE), BRAF V600E mutation, TERT promoter mutation, and high-risk histological subtypes were reported to be correlated with RAIR-DTC respectively, according to different retrospective studies, with an unfavorable median overall survival (OS) (12)(13)(14). While factors identified in each study alone still showed poor performance in predicting individual risk of RAIR, thus a predictive model is needed to integrate multiple factors as a whole.…”

Section: Introductionmentioning

confidence: 99%

A user-friendly nomogram for predicting radioiodine refractory differentiated thyroid cancer

Meng

Song²,

Wen³

et al. 2023

Front. Endocrinol.

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BackgroundThe diagnosis of radioiodine refractory differentiated thyroid cancer (RAIR-DTC) is primarily based on clinical evolution and iodine uptake over the lesions, which is still time-consuming, thus urging a predictive model for timely RAIR-DTC informing. The aim of this study was to develop a nomogram model for RAIR prediction among DTC patients with distant metastases (DM).MethodsData were extracted from the treatment and follow-up databases of Peking Union Medical College Hospital between 2010 and 2021. A total of 124 patients were included and divided into RAIR (n=71) and non-RAIR (n=53) according to 2015 ATA guidelines. All patients underwent total thyroidectomy followed by at least two courses of RAI treatment. Serological markers and various clinical, pathological, genetic status, and imaging factors were integrated into this study. The pre-treatment stimulated Tg and pre- and post-treatment suppressed Tg at the first and second course RAI treatment were defined as s-Tg1, s-Tg2, sup-Tg1, and sup-Tg2, respectively. Δs-Tg denoted s-Tg1/s-Tg2, and Δs-TSH denoted s-TSH1/s-TSH2. Multivariate logistic regression and correlation analysis were utilized to determine the independent predictors of RAIR. The performance of the nomogram was assessed by internal validation and receiver operating characteristic (ROC) curve, and benefit in clinical decision-making was assessed using decision curve.ResultsIn univariate logistic regression, nine possible risk factors were related to RAIR. Correlation analysis showed four of the above factors associated with RAIR. Through multivariate logistic regression, Δs-Tg/Δs-TSH<1.50 and age upon diagnosis were obtained to develop a convenient nomogram model for predicting RAIR. The model was internally validated and had good predictive efficacy with an AUC of 0.830, specificity of 0.830, and sensitivity of 0.755. The decision curve also showed that if the model is used for clinical decision-making when the probability threshold is between 0.23 and 0.97, the net benefit of patients is markedly higher than that of the TreatAll and TreatNone control groups.By using 1.50 as a cut-off ofΔs-Tg/Δs-TSH, differing biochemical progression among the generally so-called RAIR can be further stratified as meaningfully rapidly or slowly progressive patients (P=0.012).ConclusionsA convenient user-friendly nomogram model was developed with good predictive efficacy for RAIR. The progression of RAIR can be further stratified as rapidly or slowly progressive by using 1.50 as a cut-off value of Δs-Tg/Δs-TSH.

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Predictive Factors for RAI-Refractory Disease and Short Overall Survival in PDTC

Cited by 14 publications

References 29 publications

Markedly elevated serum preoperative thyroglobulin predicts radioiodine‐refractory thyroid cancer

Markedly elevated serum preoperative thyroglobulin predicts radioiodine‐refractory thyroid cancer

Molecular Imaging and Theragnostics of Thyroid Cancers

A user-friendly nomogram for predicting radioiodine refractory differentiated thyroid cancer

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