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

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

RAI after lymphadenectomy for DTC relapse is significantly associated with better PFS only in patients with Tg-on ≥1 ng/ml.

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Authors and Affiliations

  1. Department of Nuclear Medicine, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy

    Arnoldo Piccardo, Gianluca Bottoni, Bassam Dib, Vania Altrinetti, Michela Massollo, Irene Bossert & Manlio Cabria

  2. Clinical Trial Unit, Office of the Scientific Director, Galliera Hospital, Genoa, Italy

    Matteo Puntoni

  3. Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland

    Giorgio Treglia & Luca Giovanella

  4. Internal Medicine, Galliera Hospital, Genoa, Italy

    Luca Foppiani

  5. Department of Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy

    Mattia Bertoli & Francesco Bertagna

  6. Department of Surgery, Thyroid Centre, Galliera Hospital, Genoa, Italy

    Ugo Catrambone & Anselmo Arlandini

Authors
  1. Arnoldo Piccardo
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  2. Matteo Puntoni
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  3. Gianluca Bottoni
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  4. Giorgio Treglia
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  5. Luca Foppiani
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  6. Mattia Bertoli
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  7. Ugo Catrambone
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  8. Anselmo Arlandini
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  9. Bassam Dib
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  10. Vania Altrinetti
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  11. Michela Massollo
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  12. Irene Bossert
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  13. Manlio Cabria
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  14. Francesco Bertagna
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  15. Luca Giovanella
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Corresponding author

Correspondence to Arnoldo Piccardo.

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Funding

This research did not receive any specific grant from any funding agency in the public, commercial or non-profit sector.

Conflict of interest

The authors have nothing to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964

Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Francesco Bertagna and Luca Giovanella share senior co-authorship.

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Piccardo, A., Puntoni, M., Bottoni, G. et al. Differentiated Thyroid Cancer lymph-node relapse. Role of adjuvant radioactive iodine therapy after lymphadenectomy. Eur J Nucl Med Mol Imaging 44, 926–934 (2017). https://doi.org/10.1007/s00259-016-3593-0

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  • DOI: https://doi.org/10.1007/s00259-016-3593-0

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