Tumor burden of persistent disease in patients with differentiated thyroid cancer: correlation with postoperative risk-stratification and impact on outcome.
Adult
Aged
Female
Follow-Up Studies
Humans
Iodine Radioisotopes
/ administration & dosage
Male
Middle Aged
Positron Emission Tomography Computed Tomography
Postoperative Period
Prognosis
Radiotherapy, Adjuvant
/ methods
Retrospective Studies
Risk Assessment
/ methods
Risk Factors
Single Photon Emission Computed Tomography Computed Tomography
Thyroid Gland
/ diagnostic imaging
Thyroid Neoplasms
/ diagnosis
Thyroidectomy
Treatment Outcome
Tumor Burden
18FDG PET/CT
Differentiated thyroid cancer
Radioiodine
Risk-stratification
Tumor burden
Journal
BMC cancer
ISSN: 1471-2407
Titre abrégé: BMC Cancer
Pays: England
ID NLM: 100967800
Informations de publication
Date de publication:
14 Aug 2020
14 Aug 2020
Historique:
received:
13
02
2020
accepted:
06
08
2020
entrez:
18
8
2020
pubmed:
18
8
2020
medline:
15
4
2021
Statut:
epublish
Résumé
In patients with differentiated thyroid cancer (DTC), tumor burden of persistent disease (PD) is a variable that could affect therapy efficiency. Our aim was to assess its correlation with the 2015 American Thyroid Association (ATA) risk-stratification system, and its impact on response to initial therapy and outcome. This retrospective cohort study included 618 consecutive DTC patients referred for postoperative radioiodine (RAI) treatment. Patients were risk-stratified using the 2015 ATA guidelines according to postoperative data, before RAI treatment. Tumor burden of PD was classified into three categories, i.e. very small-, small- and large-volume PD. Very small-volume PD was defined by the presence of abnormal foci on post-RAI scintigraphy with SPECT/CT or PD was evidenced in 107 patients (17%). Mean follow-up for patients with PD was 7 ± 3 years. The percentage of large-volume PD increased with the ATA risk (18, 56 and 89% in low-, intermediate- and high-risk patients, respectively, p < 0.0001). There was a significant trend for a decrease in excellent response rate from the very small-, small- to large-volume PD groups at 9-12 months after initial therapy (71, 20 and 7%, respectively; p = 0.01) and at last follow-up visit (75, 28 and 16%, respectively; p = 0.04). On multivariate analysis, age ≥ 45 years, distant and/or thyroid bed disease, small-volume or large-volume tumor burden and The tumor burden of PD correlates with the ATA risk-stratification, affects the response to initial therapy and is an independent predictor of residual disease after a mean 7-yr follow-up. This variable might be taken into account in addition to the postoperative ATA risk-stratification to refine outcome prognostication after initial treatment.
Sections du résumé
BACKGROUND
BACKGROUND
In patients with differentiated thyroid cancer (DTC), tumor burden of persistent disease (PD) is a variable that could affect therapy efficiency. Our aim was to assess its correlation with the 2015 American Thyroid Association (ATA) risk-stratification system, and its impact on response to initial therapy and outcome.
METHODS
METHODS
This retrospective cohort study included 618 consecutive DTC patients referred for postoperative radioiodine (RAI) treatment. Patients were risk-stratified using the 2015 ATA guidelines according to postoperative data, before RAI treatment. Tumor burden of PD was classified into three categories, i.e. very small-, small- and large-volume PD. Very small-volume PD was defined by the presence of abnormal foci on post-RAI scintigraphy with SPECT/CT or
RESULTS
RESULTS
PD was evidenced in 107 patients (17%). Mean follow-up for patients with PD was 7 ± 3 years. The percentage of large-volume PD increased with the ATA risk (18, 56 and 89% in low-, intermediate- and high-risk patients, respectively, p < 0.0001). There was a significant trend for a decrease in excellent response rate from the very small-, small- to large-volume PD groups at 9-12 months after initial therapy (71, 20 and 7%, respectively; p = 0.01) and at last follow-up visit (75, 28 and 16%, respectively; p = 0.04). On multivariate analysis, age ≥ 45 years, distant and/or thyroid bed disease, small-volume or large-volume tumor burden and
CONCLUSIONS
CONCLUSIONS
The tumor burden of PD correlates with the ATA risk-stratification, affects the response to initial therapy and is an independent predictor of residual disease after a mean 7-yr follow-up. This variable might be taken into account in addition to the postoperative ATA risk-stratification to refine outcome prognostication after initial treatment.
Identifiants
pubmed: 32799836
doi: 10.1186/s12885-020-07269-3
pii: 10.1186/s12885-020-07269-3
pmc: PMC7429727
doi:
Substances chimiques
Iodine Radioisotopes
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
765Références
J Clin Endocrinol Metab. 2006 Feb;91(2):498-505
pubmed: 16303836
Eur J Cancer. 2018 Mar;92:40-47
pubmed: 29413688
Endocrine. 2014 Sep;47(1):266-72
pubmed: 24366637
Eur J Endocrinol. 2014 Aug;171(2):247-52
pubmed: 24866576
J Clin Endocrinol Metab. 2015 Jan;100(1):132-40
pubmed: 25303481
J Nucl Med. 1993 Oct;34(10):1626-31
pubmed: 8410272
Thyroid. 2016 Jan;26(1):1-133
pubmed: 26462967
J Clin Endocrinol Metab. 2017 Jun 1;102(6):1898-1907
pubmed: 28323937
J Clin Endocrinol Metab. 2017 Mar 01;102(3):1020-1031
pubmed: 28359102
PLoS One. 2016 Sep 06;11(9):e0162482
pubmed: 27598385
J Clin Endocrinol Metab. 2009 Jun;94(6):2075-84
pubmed: 19276233
Eur J Endocrinol. 2011 Jun;164(6):961-9
pubmed: 21471170
Eur J Nucl Med Mol Imaging. 2010 Apr;37(4):699-705
pubmed: 19936746
Hum Pathol. 2007 Feb;38(2):212-9
pubmed: 17097131
J Clin Endocrinol Metab. 2006 Aug;91(8):2892-9
pubmed: 16684830
EJNMMI Res. 2018 Dec 3;8(1):104
pubmed: 30511173
Cancer. 2017 Aug 1;123(15):2955-2964
pubmed: 28369717