Radioiodine refractoriness score: A multivariable prediction model for postoperative radioiodine‐refractory differentiated thyroid carcinomas

Abstract

ObjectiveThe purpose of the present study was to evaluate the clinical features of patients with radioiodine refractory (RAIR) differentiated thyroid carcinoma (DTC) and establish an effective risk score for postoperative radioiodine refractoriness.Subjects and methodsData were retrospectively collected from 5163 patients admitted to our center after thyroid surgery. Radioiodine refractoriness was defined according to criteria used in the 2015 American Thyroid Association guidelines. The scoring system was established by independent risk factors identified by univariate and multivariate analyses. The optimal index points for predicting the prevalence of radioiodine refractoriness and the model discriminatory power were assessed by receiver operating characteristic (ROC) curves.ResultsOne hundred and twelve (2.2%) patients developed RAIR DTC. Smoking, tumor type (follicular thyroid cancer), extrathyroid extension, lymph node metastasis number (≥4), lymph node metastasis rate (≥53%), and pN stage (N1) were highly positively correlated with the prevalence of RAIR DTC. The cutoff value of seven points was found to be the best for predicting the prevalence of RAIR DTC, and the scoring system presented better discrimination than other single independent predictors.ConclusionsBased on our multivariable prediction model, patients with ≥7 index points may need to undergo more active surveillance or aggressive treatment due to the high risk of RAIR DTC.

Clinical, Pathological, and Molecular Characteristics Correlating to the Occurrence of Radioiodine Refractory Differentiated Thyroid Carcinoma: A Systematic Review and Meta-Analysis

“…Forty-six remaining studies were retrieved for assessment, and a flow chart showed the process of literature retrieval (Figure 1). Of 13 eligible articles, 12 were retrospective studies, and one study from China was prospective (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Two appropriate reports were included, although they were conference abstracts.…”

“…Here, we drew the opposite conclusion. Three studies including 100 RR-DTCs and 115 controls were analyzed in this part: two from China (11,17) and one from America (12). In the sensitivity analysis, deletion of one study (11) changed the high heterogeneity into no heterogeneity.…”

“…Therefore, the great difference would be reconciled if this part of the data were complete. Although the subgroup analysis for LLNM was not conducted due to the similar study number limitation as tumor size, the outcome was relatively reliable because the literature remaining ( 11 , 17 ) contained many patients, specifically 403 patients with DTC, of whom 145 were diagnosed with RR-DTC. LLNM is a predictor of the prognosis of DTC ( 32 – 34 ), which reflects the aggressiveness of tumors similar to ETE.…”

Enhancement of211At Uptake via the Sodium Iodide Symporter by the Addition of Ascorbic Acid in Targeted α-Therapy of Thyroid Cancer

“…131 I is used for the ablation of thyroid remnants or treatment of metastatic thyroid cancer (1). However, some patients with multiple metastases are refractory to repetitive 131 I treatment, despite the targeted regions showing sufficient iodine uptake (4,5). According to the criteria described in the 2015 American Thyroid Association guidelines, radioactive iodine–refractory cancer includes metastatic disease that progresses despite showing substantial uptake of radioactive iodine (6).…”

Ultrasound characteristics of cervical lesions in patients with radioiodine refractory differentiated thyroid cancer

“…In previous study, Smoking, tumor type (follicular thyroid cancer), extrathyroid extension, lymph node metastasis, and pN stage were highly correlated with the prevalence of RAIR DTC. [23] It may help obtain more time for the effective therapeutic options, such as tyrosine kinase inhibitor. Ultrasound (US) shows a high accuracy in cervical lymph node recurrence and diagnosing soft tissue lesions such as musculoskeletal disorders.…”