Differentiated Thyroid Cancer lymph-node relapse. Role of adjuvant radioactive iodine therapy after lymphadenectomy.

Détails

ID Serval
serval:BIB_4179FC791416
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Differentiated Thyroid Cancer lymph-node relapse. Role of adjuvant radioactive iodine therapy after lymphadenectomy.
Périodique
European journal of nuclear medicine and molecular imaging
Auteur(s)
Piccardo A., Puntoni M., Bottoni G., Treglia G., Foppiani L., Bertoli M., Catrambone U., Arlandini A., Dib B., Altrinetti V., Massollo M., Bossert I., Cabria M., Bertagna F., Giovanella L.
ISSN
1619-7089 (Electronic)
ISSN-L
1619-7070
Statut éditorial
Publié
Date de publication
06/2017
Peer-reviewed
Oui
Volume
44
Numéro
6
Pages
926-934
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
Our purpose as to evaluate the impact of adjuvant radioactive iodine therapy (RAI) on prognosis, as assessed by progression-free survival (PFS) and overall survival (OS), in patients affected by differentiated thyroid carcinoma (DTC) lymph-node relapse and previously treated with lymphadenectomy.
We retrospectively evaluated DTC patients treated with lymph-node dissection for disease relapse. All patients had previously undergone total thyroidectomy and radioiodine remnant ablation (RRA). We used clinical and histological data obtained during follow-up to assess response and outcome. By means of univariate and multivariate time-to-event analyses, we assessed the impact of RAI on outcome (PFS and OS) and the prognostic role of thyroglobulin (Tg) levels under suppression with levothyroxine (Tg-on) measured 1-3 months after lymphadenectomy and of other risk factors.
We evaluated 113 patients (age at diagnosis: median 41 years, interquartile range: 31-59), 64 of whom were treated with RAI. Over a median follow-up time of 5.7 years, 27 patients showed disease progression and 13 died. Kaplan-Meier PFS and OS curves showed that age on diagnosis, tumor histology, tumor size, DTC aggressive variant, and Tg-on were associated with prognosis. Patients with Tg-on ≥1 ng/ml treated with RAI showed a better PFS (Log-rank pp 0.001) and OS (p = 0.005) than untreated patients, while no effect of RAI was observed in patients with Tg-on <1 ng/ml. Multivariate models showed that age, Tg-on (≥1 vs. < 1 ng/ml, HR: 18.2, 95% CI: 5.09-64.8, p = 0.001) and RAI (Yes vs. No, HR: 0.36,95%CI: 0.15-0. 9, p = 0.02) remained the only independent factors associated with PFS, but only age and Tg-on remained significantly associated with OS (HR: 8.31, 95%CI:1.56-44.3, p = 0.01). Nonetheless, patients treated with RAI showed a lower risk of mortality (HR: 0.34, 95%CI: 0.1-1.15 p = 0.08) than untreated patients.
RAI after lymphadenectomy for DTC relapse is significantly associated with better PFS only in patients with Tg-on ≥1 ng/ml.

Mots-clé
Adjuvant RAI, Differentiated thyroid cancer, Lymphadenectomy, Prognosis
Pubmed
Web of science
Création de la notice
20/08/2017 17:26
Dernière modification de la notice
03/03/2018 16:33
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