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.
Highlights
Differentiated thyroid carcinomas (DTCs), including papillary and follicular types based on histopathological criteria, account for approximately 90% of thyroid malignancies.[1]The standard primary treatments for differentiated thyroid carcinoma (DTC) mainly include surgery, radioactive iodine (RAI) therapy, and thyroid‐stimulating hormone (TSH) suppression therapy.[2]
We focused on investigating the association of different clinical parameters with radioiodine refractory (RAIR) cancer to identify independent predictors and established an effective multivariable prediction model to evaluate the risk of RAIR cancer
RAIR cancer was defined according to the criteria used in the 2015 American Thyroid Association guidelines, as follows: (a) metastatic disease that does not take up RAI at the time of the first 131I treatment; (b) ability to take up RAI lost after previous evidence of uptake; (c) RAI uptake retained in some lesions but not in others; or (d) metastatic disease that progresses despite substantial uptake of RAI.[11]
Summary
This study was supported by grants from National Key R&D Program of China (2017YF0907504), National Natural Science Foundation (81702646), National Post‐Doctor Research Project (186717), Sichuan Province Science and Technology Project of China (2017SZ0139), Sichuan University for youth fund (2017SCU11016), Health and Family Planning Commission of Sichuan Province (17PJ398), and Postdoctoral Sustentation Fund of Sichuan University (2017SCU12035).
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