Arnoldo Piccardo1, Matteo Puntoni2, Gianluca Bottoni3, Giorgio Treglia4, Luca Foppiani5, Mattia Bertoli6, Ugo Catrambone7, Anselmo Arlandini7, Bassam Dib3, Vania Altrinetti3, Michela Massollo3, Irene Bossert3, Manlio Cabria3, Francesco Bertagna6, Luca Giovanella4. 1. Department of Nuclear Medicine, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy. arnoldo.piccardo@galliera.it. 2. Clinical Trial Unit, Office of the Scientific Director, Galliera Hospital, Genoa, Italy. 3. Department of Nuclear Medicine, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy. 4. Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland. 5. Internal Medicine, Galliera Hospital, Genoa, Italy. 6. Department of Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy. 7. Department of Surgery, Thyroid Centre, Galliera Hospital, Genoa, Italy.
Abstract
PURPOSE: Our purpose as to evaluate the impact of adjuvant radioactive iodine therapy (RAI) on prognosis, as assessed by progression-free survival (PFS) and overall survival (OS), in patients affected by differentiated thyroid carcinoma (DTC) lymph-node relapse and previously treated with lymphadenectomy. METHODS: We retrospectively evaluated DTC patients treated with lymph-node dissection for disease relapse. All patients had previously undergone total thyroidectomy and radioiodine remnant ablation (RRA). We used clinical and histological data obtained during follow-up to assess response and outcome. By means of univariate and multivariate time-to-event analyses, we assessed the impact of RAI on outcome (PFS and OS) and the prognostic role of thyroglobulin (Tg) levels under suppression with levothyroxine (Tg-on) measured 1-3 months after lymphadenectomy and of other risk factors. RESULTS: We evaluated 113 patients (age at diagnosis: median 41 years, interquartile range: 31-59), 64 of whom were treated with RAI. Over a median follow-up time of 5.7 years, 27 patients showed disease progression and 13 died. Kaplan-Meier PFS and OS curves showed that age on diagnosis, tumor histology, tumor size, DTC aggressive variant, and Tg-on were associated with prognosis. Patients with Tg-on ≥1 ng/ml treated with RAI showed a better PFS (Log-rank pp 0.001) and OS (p = 0.005) than untreated patients, while no effect of RAI was observed in patients with Tg-on <1 ng/ml. Multivariate models showed that age, Tg-on (≥1 vs. < 1 ng/ml, HR: 18.2, 95% CI: 5.09-64.8, p = 0.001) and RAI (Yes vs. No, HR: 0.36,95%CI: 0.15-0. 9, p = 0.02) remained the only independent factors associated with PFS, but only age and Tg-on remained significantly associated with OS (HR: 8.31, 95%CI:1.56-44.3, p = 0.01). Nonetheless, patients treated with RAI showed a lower risk of mortality (HR: 0.34, 95%CI: 0.1-1.15 p = 0.08) than untreated patients. CONCLUSIONS: RAI after lymphadenectomy for DTC relapse is significantly associated with better PFS only in patients with Tg-on ≥1 ng/ml.
PURPOSE: Our purpose as to evaluate the impact of adjuvant radioactive iodine therapy (RAI) on prognosis, as assessed by progression-free survival (PFS) and overall survival (OS), in patients affected by differentiated thyroid carcinoma (DTC) lymph-node relapse and previously treated with lymphadenectomy. METHODS: We retrospectively evaluated DTCpatients treated with lymph-node dissection for disease relapse. All patients had previously undergone total thyroidectomy and radioiodine remnant ablation (RRA). We used clinical and histological data obtained during follow-up to assess response and outcome. By means of univariate and multivariate time-to-event analyses, we assessed the impact of RAI on outcome (PFS and OS) and the prognostic role of thyroglobulin (Tg) levels under suppression with levothyroxine (Tg-on) measured 1-3 months after lymphadenectomy and of other risk factors. RESULTS: We evaluated 113 patients (age at diagnosis: median 41 years, interquartile range: 31-59), 64 of whom were treated with RAI. Over a median follow-up time of 5.7 years, 27 patients showed disease progression and 13 died. Kaplan-Meier PFS and OS curves showed that age on diagnosis, tumor histology, tumor size, DTC aggressive variant, and Tg-on were associated with prognosis. Patients with Tg-on ≥1 ng/ml treated with RAI showed a better PFS (Log-rank pp 0.001) and OS (p = 0.005) than untreated patients, while no effect of RAI was observed in patients with Tg-on <1 ng/ml. Multivariate models showed that age, Tg-on (≥1 vs. < 1 ng/ml, HR: 18.2, 95% CI: 5.09-64.8, p = 0.001) and RAI (Yes vs. No, HR: 0.36,95%CI: 0.15-0. 9, p = 0.02) remained the only independent factors associated with PFS, but only age and Tg-on remained significantly associated with OS (HR: 8.31, 95%CI:1.56-44.3, p = 0.01). Nonetheless, patients treated with RAI showed a lower risk of mortality (HR: 0.34, 95%CI: 0.1-1.15 p = 0.08) than untreated patients. CONCLUSIONS:RAI after lymphadenectomy for DTC relapse is significantly associated with better PFS only in patients with Tg-on ≥1 ng/ml.
Authors: R Michael Tuttle; Hernan Tala; Jatin Shah; Rebecca Leboeuf; Ronald Ghossein; Mithat Gonen; Matvey Brokhin; Gal Omry; James A Fagin; Ashok Shaha Journal: Thyroid Date: 2010-10-29 Impact factor: 6.568
Authors: David S Cooper; Gerard M Doherty; Bryan R Haugen; Bryan R Hauger; Richard T Kloos; Stephanie L Lee; Susan J Mandel; Ernest L Mazzaferri; Bryan McIver; Furio Pacini; Martin Schlumberger; Steven I Sherman; David L Steward; R Michael Tuttle Journal: Thyroid Date: 2009-11 Impact factor: 6.568
Authors: A Polachek; D Hirsch; G Tzvetov; S Grozinsky-Glasberg; I Slutski; J Singer; R Weinstein; I Shimon; C A Benbassat Journal: J Endocrinol Invest Date: 2011-05-30 Impact factor: 4.256
Authors: Mark L Urken; Mira Milas; Gregory W Randolph; Ralph Tufano; Donald Bergman; Victor Bernet; Elise M Brett; James D Brierley; Rhoda Cobin; Gerard Doherty; Joshua Klopper; Stephanie Lee; Josef Machac; Jeffrey I Mechanick; Lisa A Orloff; Douglas Ross; Robert C Smallridge; David J Terris; Jason B Clain; Michael Tuttle Journal: Head Neck Date: 2014-04-03 Impact factor: 3.147
Authors: Frederik A Verburg; Uwe Mäder; Karina Tanase; Elena-Daphne Thies; Stefanie Diessl; Andreas K Buck; Markus Luster; Christoph Reiners Journal: J Clin Endocrinol Metab Date: 2012-11-12 Impact factor: 5.958
Authors: Elizabeth J de Koster; Taban Sulaiman; Jaap F Hamming; Abbey Schepers; Marieke Snel; Floris H P van Velden; Lioe-Fee de Geus-Oei; Dennis Vriens Journal: Diagnostics (Basel) Date: 2021-03-19