考虑早期动态风险分层以指导分化甲状腺癌患者的肿瘤学随访排出
Consideration of Early Dynamic Risk Stratification to Guide Discharge from Oncologic Follow-Up in Patients with Differentiated Thyroid Cancer
影响因子:6.70000
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
摘要
背景：目前的教条是对卵泡衍生的甲状腺癌（DTC）治疗的患者的终身随访。我们的主要目的是确定一系列DTC患者复发的时间，对治疗术后6个月后，对治疗的反应出色和放射性碘治疗。次要目标是确定怀疑复发的时间并确定与复发有关的因素。方法：这项回顾性队列研究包括在2008年至2012年之间接受了DTC治疗的患者，以及甲状腺全切除术和放射性碘治疗后6个月的缓解。根据2015年ATA（美国甲状腺甲状腺协会）指南，缓解的标准是负成像，并抑制甲状腺球蛋白（TG）<0.2 ng/ml或Rh-TSH-（重组人TSH）刺激Tg <1 ng/ml。复发是通过细胞学和/或组织学证明的宫颈淋巴结转移或第二次放射性碘处理的定义。结果：在接受DTC治疗的721例患者中，由于持续性疾病在6个月时被排除在外，由于持续性疾病，由于缺少随访数据，其中包括492例。平均随访时间和中位随访时间为7。0年和7。9年（四分位数IQR [2.1-11.3]）。根据2015年ATA指南，对7例患者（1.4％），1例最初归类为高复发风险，3个为低风险的患者发生了复发。所有复发均发生在初始管理后的10年内（最初5年内4个）。对于复发的患者，在最初的8年中的七个病例中的六个病例中，TG和/或可疑淋巴结升高，并且在初次手术后的最后一个病例中，检测到了最后一个病例。结论：甲状腺切除术和放射性二世后6个月的反应良好的低和中间复发风险DTC患者以及10年后的缓解中的复发风险极低。从这个时间点开始，初级保健提供者可能会进行后续。这些排放建议应通过进一步的前瞻性研究确认。
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.