考虑早期动态风险分层以指导甲状腺分化癌患者出院随访的策略

Consideration of Early Dynamic Risk Stratification to Guide Discharge from Oncologic Follow-Up in Patients with Differentiated Thyroid Cancer

THYROID

影响因子:6.7

分区:医学1区 Top / 内分泌学与代谢1区

发表日期:2024 Dec

作者: Amina Attia, Eliane Touma, Charlotte Lussey-Lepoutre, Cécile Ghander, Anne Jouinot, Malanie Roy, Selma Housni, Nathalie Chereau, Fabrice Menegaux, Laurence Leenhardt, Camille Buffet

DOI: 10.1089/thy.2024.0119

摘要

背景：目前的临床观念是对甲状腺滤泡样分化甲状腺癌（DTC）患者进行终生随访。我们的主要目标是确定在全甲状腺切除术及放射性碘治疗后6个月内反应良好的DTC患者的复发时间。次要目标是确定复发的疑似时间及相关因素。方法：这是一项回顾性队列研究，纳入2008年至2012年接受治疗且在6个月后达成缓解的DTC患者。缓解标准为影像学检查阴性、促甲状腺素（Tg）抑制后<0.2 ng/mL或重组人促甲状腺素（rh-TSH）刺激Tg<1 ng/mL（依据2015年美国甲状腺协会指南）。复发定义为细胞学或组织学证实的颈部淋巴结转移或二次放射性碘治疗的实施。结果：在721名DTC患者中，158名因持续疾病被排除，71名缺失随访数据，最终纳入492名。平均随访时间为7.0年，中位随访为7.9年（四分位距IQR 2.1-11.3）。7例患者（1.4%）发生复发，其中1例属高复发风险，3例中等风险，3例低风险（依据2015年ATA指南）。所有复发均发生在初次治疗后10年内（4例在前5年内）。复发患者中，Tg升高和/或可疑淋巴结在初次手术后8年内被检测到，最后一例发生在10年后。结论：在全甲状腺切除术和放射性碘治疗后6个月内反应良好且在10年随访中处于缓解状态的低至中等复发风险DTC患者，其复发风险极低。由初级医疗提供者从此时起进行随访可能是合理的。这些出院建议应通过进一步的前瞻性研究予以验证。

Abstract

Background: The current dogma is a life-long follow-up for patients treated for follicular-derived differentiated thyroid cancers (DTC). Our primary objective was to determine the time to recurrence in a series of DTC patients with an excellent response to therapy 6 months after total thyroidectomy and radioiodine therapy. The secondary objectives were to determine the time to suspicion of recurrence and to identify factors associated with recurrence. Methods: This retrospective cohort study included patients treated for DTC between 2008 and 2012 and in remission 6 months after total thyroidectomy and radioiodine treatment. The criteria for remission were negative imaging and suppressed thyroglobulin (Tg) <0.2 ng/mL or rh-TSH-(recombinant human TSH) stimulated Tg <1 ng/mL according to the 2015 ATA (American Thyroid Association) guidelines. Recurrence was defined by cytologically and/or histologically proven cervical lymph node metastasis or the administration of a second radioiodine treatment. Results: Among 721 patients treated for DTC, 158 were excluded because of persistent disease at 6 months, 71 because of missing follow-up data, and 492 were included. The mean and median follow-up time were 7.0 and 7.9 years (interquartile range IQR [2.1-11.3]). Recurrence occurred for 7 patients (1.4%), 1 initially classified as high recurrence risk, 3 as intermediate, and 3 as low risk according to the 2015 ATA guidelines. All relapses occurred within 10 years after initial management (4 within the first 5 years). For patients with recurrence, rise in Tg and/or suspicious lymph nodes were detected in six out of seven cases in the first 8 years and for the last case 10 years after initial surgery. Conclusion: Low and intermediate recurrence risk DTC patients with excellent response 6 months after total thyroidectomy and radioiodine and in remission 10 years later have an extremely low recurrence risk. Follow-up might be undertaken by primary care providers from this time point. These discharge recommendations should be confirmed by further prospective studies.