Papillary thyroid microcarcinoma should not be used as the basis for postoperative 131I therapy

doi:10.16139/j.1007-9610.2023.06.08

Abstract

Abstract:

Objective To analyze the clinicopathological data of patients with papillary thyroid microcarcinoma (PTMC) and papillary thyroid non-microcarcinoma (non-PTMC) who received ¹³¹I therapy retrospectively, and compare the therapeutic response of the two groups of patients, so as to guide ¹³¹I therapy decisions for PTMC patients. Methods A total of 1 118 patients with papillary thyroid carcinoma (PTC) underwent ¹³¹I therapy in the Department of Nuclear Medicine, Tianjin Medical University General Hospital from January 2015 to December 2020 were enrolled. Chi-square test and Mann-Whitney U test were used to compare the differences of clinicopathological features and ¹³¹I therapy， therapeutic response between two groups. The incomplete response （IR）rate curves of the two groups were plotted by Kaplan-Meier analysis.Results The proportion of patients with multifocal, involvement of bilateral thyroid lobes in PTMC group were higher than those in non-PTMC group, and the proportion of patients with extra-thyroid extension, T4, N1b, stimulated thyroglobulin(sTg)>10 μg/L, and high risk stratified were lower than those in non-PTMC group (P<0.05). Most patients in PTMC group received remnant ablation for the first time, while more patients in non-PTMC group received adjuvant therapy and therapy for known disease (P<0.05). There was no statistically significant difference in ¹³¹I therapeutic response, the rates of excellent response(ER) and IR in two groups, and the differences in curves of IR rate between the two groups were also no statistically significance (P>0.05). Conclusions PTMC has a certain degree of invasiveness. As long as the patients were comprehensively evaluated and the standard ¹³¹I therapy was adopted, the treatment outcomes of patients with PTMC and non-PTMC were roughly the same. Therefore, the clinical value of the definition of PTMC is extremely limited in the formulation of ¹³¹I therapeutic dose regimens.

Key words: Thyroid tumor, Papillary thyroid carcinoma, Radiotherapy, Iodine radioisotope, Treatment outcome

CLC Number:

R736.1

CAI Xiaoyu, ZHANG Ruiguo, HU Yujing, WANG Renfei, BIAN Yanzhu. Papillary thyroid microcarcinoma should not be used as the basis for postoperative ¹³¹I therapy[J]. Journal of Surgery Concepts & Practice, 2023, 28(06): 529-535.

Figures/Tables 8

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References 24

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Characteristics		PTMC(n=458)	non-PTMC(n=660)	Test value	P value
Age（year）	<55	359（78.4）	507（76.8）	0.380	0.561
Age（year）	≥55	99（21.6）	153（23.2）	0.380	0.561
Gender	Male	130（28.4）	223（33.8）	3.654	0.058
Gender	Female	328（71.6）	437（66.2）	3.654	0.058
Number of lesions	Unifocal	132（28.8）	263（39.8）	14.390	0.000
Number of lesions	Multifocal	326（71.2）	397（60.2）	14.390	0.000
Involvement of thyroid lobes	Unilateral thyroid lobe	193（42.1）	325（49.2）	5.485	0.021
Involvement of thyroid lobes	Bilateral thyroid lobes	265（57.9）	335（50.8）	5.485	0.021
Pathological subtype	Non-invasive	451（98.5）	642（97.3）	1.778	0.220
Pathological subtype	Invasive	7（1.5）	8（2.7）	1.778	0.220
Extra-thyroid extension	No	350（76.4）	413（62.6）	23.910	0.000
Extra-thyroid extension	Yes	108（23.6）	247（37.4）	23.910	0.000
T4 stage	No	431（94.1）	593（89.8）	6.361	0.012
T4 stage	Yes	27（5.9）	67（10.2）	6.361	0.012
lymph node metastasis	N0	91（19.9）	102（15.5）	23.382	0.000
	N1a	224（48.9）	257（38.9）
	N1b	143（31.2）	301（45.6）
Distant metastasis	No	441（96.3）	625（94.7）	1.544	0.249
Distant metastasis	Yes	17（3.7）	35（5.3）	1.544	0.249
sTg of pre-therapy（μg/L）	<1	162（35.4）	158（23.9）	24.321	0.000
	1-10	209（45.6）	307（46.5）
	≥10	87（19.0）	195（29.5）
Recurrence risk stratification	Low risk	65（14.2）	50（7.6）	30.800	0.000
	Moderate risk	272（59.4）	340（51.5）
	High risk	121（26.4）	270（40.9）

Item		PTMC(n=458)	non-PTMC(n=660)	Test value	P value
Goal of the initial therapy	Remnant ablation	294（64.2）	308（46.7）	34.492	0.000
	Adjuvant therapy	138（30.1）	282（42.7）
	¹³¹I therapy	26（5.7）	70（10.6）
Initial therapeutic doses（GBq）	≤3.7	294（64.2）	308（46.7）	34.492	0.000
	5.55	138（30.1）	282（42.7）
	7.4	26（5.7）	70（10.6）
Cumulative therapeutic doses（GBq）	≤7.4	383（83.6）	465（70.5）	26.724	0.000
	7.4-22.2	72（15.7）	190（28.8）
	>22.2	3（0.7）	5（0.8）
Times of ¹³¹I therapy	Single	352（76.9）	417（63.2）	23.545	0.000
Times of ¹³¹I therapy	Multiple	106（23.1）	243（36.8）	23.545	0.000

Item		6 months after¹³¹I therapy				Last follow-up
Item		PTMC(n=458)	non-PTMC(n=660)	Test value	P value	PTMC(n=458)	non-PTMC(n=660)	Test value	P valu
Therapeutic response	ER	189（64.3）	178（57.8）	4.911	0.189	220（74.8）	235（76.3）	4.662	0.147
	IDR	103（35.0）	122（39.6）			74（25.2）	68（22.1）
	BIR	1（0.3）	4（1.3）			0	3（1.0）
	SIR	1（0.3）	4（1.3）			0	2（0.6）
ER	ER	189（64.3）	178（57.8）	2.665	0.113	220（74.8）	235（76.3）	0.176	0.705
ER	Non-ER	105（35.7）	130（42.2）	2.665	0.113	74（25.2）	73（23.7）	0.176	0.705
IR	IR	2（0.7）	8（2.6）	2.312	0.128	0	5（1.6）	—	0.062
IR	Non-IR	292（99.3）	300（97.4）	2.312	0.128	294（100.0）	303（98.4）	—	0.062

Item		6 months after¹³¹I therapy				Last follow-up
Item		PTMC(n=458)	non-PTMC(n=660)	Test value	P value	PTMC(n=458)	non-PTMC(n=660)	Test value	P value
Therapeutic response	ER	53（38.4）	86（30.5）	4.950	0.173	71（51.4）	133（47.2）	1.978	0.575
	IDR	37（26.8）	85（30.1）			41（29.7）	88（31.2）
	BIR	32（23.3）	87（30.9）			17（12.3）	47（16.7）
	SIR	16（11.6）	24（8.5）			9（6.5）	14（5.0）
ER	ER	53（38.4）	86（30.5）	2.618	0.122	71（51.4）	133（47.2）	0.681	0.467
ER	Non-ER	85（61.6）	196（69.5）	2.618	0.122	67（48.6）	149（52.8）	0.681	0.467
IR	IR	48（34.8）	111（39.4）	0.862	0.393	26（18.8）	61（21.6）	0.439	0.525
IR	Non-IR	90（65.2）	171（60.6）	0.862	0.393	112（81.2）	221（78.4）	0.439	0.525
SIR	SIR	16（11.6）	24（8.5）	1.022	0.376	9（6.5）	14（5.0）	0.434	0.649
SIR	Non-SIR	122（88.4）	258（91.5）	1.022	0.376	129（93.5）	268（95.0）	0.434	0.649

Item		PTMC (n=458)	non-PTMC (n=660)	Test value	P value
Therapeutic response	ER	1（3.8）	3（4.3）	1.693	0.685
	IDR	2（7.7）	6（8.6）
	BIR	4（15.4）	19（27.1）
	SIR	19（73.1）	42（60.0）
ER	ER	1（3.8）	3（4.3）	—	1.000
ER	Non-ER	25（96.2）	67（95.7）	—	1.000
IR	IR	23（88.5）	61（87.1）	0.000	1.000
IR	Non-IR	3（11.5）	9（12.9）	0.000	1.000
SIR	SIR	19（73.1）	42（60.0）	1.399	0.340
SIR	Non-SIR	7（26.9）	28（40.0）	1.399	0.340

Papillary thyroid microcarcinoma should not be used as the basis for postoperative ¹³¹I therapy

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