Postoperative Stimulated Thyroglobulin Level and Recurrence Risk Stratification in Differentiated Thyroid Cancer

• Published in: Chinese medical journal Vol. 128; no. 8; pp. 1058 - 1064
• Main Authors: Yang, Xue, Liang, Jun, Li, Tian-Jun, Yang, Ke, Liang, Dong-Quan, Yu, Zhuang, Lin, Yan-Song
• Format: Journal Article
• Language: English
• Published: China Medknow Publications Pvt Ltd 20.04.2015; Medknow Publications and Media Pvt. Ltd; Lippincott Williams & Wilkins Ovid Technologies; Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing 100730, China%Department of Oncology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China%Beijing Hui Jia(IB)Private School, Beijing 102200, China; Medknow Publications & Media Pvt Ltd; Wolters Kluwer
• Subjects: Ablation (Surgery); Ablation; Differentiated Thyroid Carcinoma; Radioiodine Therapy; Recurrence Risk Stratification; Thyroglobulin; Adult; Care and treatment; Clinical medicine; Decision making; Female; Health aspects; Histology; Hospitals; Humans; Immunoassay; Iodine Radioisotopes - therapeutic use; Lymphatic system; Male; Medical imaging; Medical prognosis; Medicine; Metastasis; Middle Aged; Nuclear medicine; Oncology; Original; Physiological aspects; Postoperative Period; Prognosis; Retrospective Studies; Surgery; Thyroglobulin; Thyroid cancer; Thyroid Neoplasms - blood; Thyroid Neoplasms - pathology; Thyroid Neoplasms - radiotherapy; 分化; 危险度; 复发; 放射性碘; 甲状腺球蛋白; 甲状腺癌; 白刺; 风险分级; Taiwan; Recurrence Risk Stratification; Differentiated Thyroid Carcinoma; Thyroglobulin; Ablation; Radioiodine Therapy
• ISSN: 0366-6999; 2542-5641
• DOI: 10.4103/0366-6999.155086

Background： Postoperative preablative stimulated thyroglobulin （ps-Tg） has been evaluated in predicting prognosis and success of ablation regarding differentiated thyroid cancer （DTC）; however, its relationship with recurrence risk and radioiodine decision-making remains uncertain, especially in Chinese DTC patients. We aimed to evaluate the association between ps-Tg and recurrence risk stratification in DTC, to provide incremental values for ps-Tg in postoperative assessment and radioiodine management. Methods： Seven hundred and seven patients with DTC were included; low-risk （L; n = 90）, intermediate-risk （I; n = 283）, and high-risk （H; n = 334, 117 with distant metastasis [M 1 ]） patients were divided according to recurrence risk stratification. The M 1 group was further analyzed regarding evidence of metastasis. Cut-off values of ps-Tg were obtained using receiver operating characteristic analysis. Results： Patients with more advanced disease at initial risk stratification were more likely to have higher ps-Tg levels （I vs. L： P 〈 0.05; H vs. 1： P 〈 0.001; H vs. L： P 〈 0.001）. The corresponding cut-off value of ps-Tg for distinguishing sensitivity and specificity in each of the two groups was 2.95 ng/ml （1 vs. L： 61.5%, 63.3%）, 29.5 ng/ml （H vs, I： 41.9%, 92.6%）, 47.1 ng/ml （M1 vs. M0 in the H group： 79.5%, 88.9%） and 47.1 ng/ml （MI vs. M0 in all patients： 79.5%, 93.7%）. With the cut-offvalue at 47.1 ng/ml, ps-Tg was the only factor that could be used to identify distant metastases, and consequently if measured before radioiodine therapy would prevent 10.26% of patients with M1 from undertreatment, Conclusions： Ps-Tg, as an ongoing reassessment marker, favors differential recurrence risk grading and provides incremental values for radioiodine treatment decision-making.