Comparison of thyroid hormone withdrawal and recombinant human thyroid-stimulating hormone administration for adjuvant therapy in patients with intermediate- to high-risk differentiated thyroid cancer
Comparison of thyroid hormone withdrawal and recombinant human thyroid-stimulating hormone administration for adjuvant therapy in patients with intermediate- to high-risk differentiated thyroid cancer
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DOI：
10.1007/s12149-020-01497-0
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发表时间：
2020-07-08
影响因子：
2.6
通讯作者：
Mizowaki, Takashi
中科院分区：
文献类型：
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作者：
Iizuka, Yusuke;Katagiri, Tomohiro;Mizowaki, Takashi
目的比较根据美国甲状腺协会（American Thyroid Association）标准行甲状腺切除术的中高危分化型甲状腺癌（Differentiated Thyroid Carcinoma，DTC）患者在术后分别采用甲状腺激素停药（Thyroid Hormone Withdrawal，THW）和重组人促甲状腺激素（recombinant human thyroid-stimulating hormone，rhTSH）两种不同制备方法进行放射性碘（Radioactive Iodium，RAI）辅助治疗的临床疗效。方法回顾性分析2012年5月至2018年10月间136例接受大剂量（3700 MBq）RAI辅助治疗的DTC患者，手术切除后无任何转移病灶或肉眼可见残留病灶。如果在辅助治疗期间确认远处转移或如果无法确认结局，则排除患者;因此，最终评价了112例患者。患者接受3周的甲状腺素停药限制或2周的rhTSH给药限制。治疗后6-12个月测定血清甲状腺球蛋白（Tg）浓度，并进行131 I放射性核素显像（370 MBq）。辅助治疗的初始成功定义为甲状腺床对（131）I的摄取消失和血清Tg浓度< 2.0 ng/mL。使用Fisher精确检验比较组间辅助治疗的结果，使用Welch t检验比较TSH水平和估计的肾小球滤过率（eGFR）。结果THW组和rhTSH组分别为47例和65例，中、高危组分别为63例和49例。没有患者被分配到低风险组。在THW和rhTSH组中，30/47例达到了初始RAI辅助治疗目标（63.8%）和46/65例患者（70.8%），分别（p = 0.54）; TSH水平的平均值±标准差分别为123.8 ± 46.4 mu IU/mL和274.5 ± 97.7 mu IU/mL eGFR（治疗/治疗前）分别为0.81和0.99（p < 0.01）。在中危组和高危组中，分别有43/63名患者（68.3%）和33/49名患者（67.3%）实现了初始RAI辅助治疗目标（p = 1.0）。结论不同制备方法对RAI辅助治疗的初步效果无明显差异。然而，rhTSH组的患者表现出较高的TSH水平和保留的eGFR。
Objective To compare the clinical outcome in patients who received adjuvant therapy with radioactive iodine (RAI) using different preparation methods, namely, thyroid hormone withdrawal (THW) and recombinant human thyroid-stimulating hormone (rhTSH), after undergoing thyroidectomy for intermediate- to high-risk differentiated thyroid carcinoma (DTC) according to the American Thyroid Association criteria. Methods Between May 2012 and October 2018, 136 patients who underwent adjuvant therapy with high-dose (3700 MBq) RAI for DTC without any metastatic lesions or macroscopic residual lesions after surgical resection were retrospectively selected. Patients were excluded if distant metastasis was confirmed during adjuvant therapy or if the outcome could not be confirmed; thus, 112 patients were finally evaluated. Patients underwent either a 3-week I restriction with thyroxine withdrawal or a 2-week I restriction with rhTSH administration. The serum thyroglobulin (Tg) concentration was measured, and(131)I scintigraphy (370 MBq) was performed 6-12 months after adjuvant therapy. The definition of the initial achievement of adjuvant therapy was the disappearance of the uptake of(131)I at the thyroid bed and serum Tg concentration < 2.0 ng/mL. The results of the adjuvant therapy between the groups were compared using the Fisher's exact test, and the TSH levels and estimated glomerular filtration rate (eGFR) were compared using the Welch's t test. Results The THW and rhTSH groups included 47 and 65 patients, respectively, and the intermediate- and high-risk groups included 63 and 49 patients, respectively. No patient was assigned to the low-risk group. In the THW and rhTSH groups, the initial RAI adjuvant therapy goal was achieved in 30/47 (63.8%) and 46/65 patients (70.8%), respectively (p = 0.54); mean +/- standard deviation of the TSH levels was 123.8 +/- 46.4 mu IU/mL and 274.5 +/- 97.7 mu IU/mL, respectively (p < 0.01), and eGFR (treatment/pre-treatment) was 0.81 and 0.99, respectively (p < 0.01). In the intermediate- and high-risk groups, the initial RAI adjuvant therapy goal was achieved in 43/63 patients (68.3%) and 33/49 (67.3%), respectively (p = 1.0). Conclusion No significant differences were observed between the preparation methods in the initial achievement of RAI adjuvant therapy. However, patients in the rhTSH group demonstrated higher TSH levels and retained eGFR.