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Clinicopathologic risk factors of radioactive iodine therapy based on response assessment in patients with differentiated thyroid cancer: a multicenter retrospective cohort study

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Abstract

Purpose

We investigated whether predictive clinicopathologic factors can be affected by different response criteria and how the clinical usefulness of radioactive iodine (RAI) therapy should be evaluated considering variable factors in patients with differentiated thyroid carcinoma (DTC).

Methods

A total of 1563 patients with DTC who underwent first RAI therapy after total or near total thyroidectomy were retrospectively enrolled from 25 hospitals. Response to therapy was evaluated with two different protocols based on combination of biochemical and imaging studies: (1) serum thyroglobulin (Tg) and neck ultrasonography (US) and (2) serum Tg, neck US, and radioiodine scan. The responses to therapy were classified into excellent and non-excellent or acceptable and non-acceptable to minimize the effect of non-specific imaging findings. We investigated which factors were associated with response to therapy depending on the follow-up protocols as well as response classifications. Multivariate logistic regression analysis was performed to identify factors significantly predicting response to therapy.

Results

The proportion of patients in the excellent response group significantly decreased from 76.5 to 59.6% when radioiodine scan was added to the follow-up protocol (P < 0.001). Preparation method (recombinant human TSH vs. thyroid hormone withdrawal) was a significant factor for excellent response prediction evaluated with radioiodine scan (OR 2.129; 95% CI 1.687–2.685; P < 0.001) but was not for other types of response classifications. Administered RAI activity, which was classified as low (1.11 GBq) or high (3.7 GBq or higher), significantly predicted both excellent and acceptable responses regardless of the follow-up protocol.

Conclusions

The clinical impact of factors related to response prediction differed depending on the follow-up protocol or classification of response criteria. A high administered activity of RAI was a significant factor predicting a favorable response to therapy regardless of the follow-up protocol or classification of response criteria.

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Acknowledgments

KSNM Thyroid Cancer CTN Retrospective Cohort Study Group: Seong Young Kwon and Subin Jeon (Chonnam National University Medical School and Hwasun Hospital, Jeonnam); Sang-Woo Lee and Shin Young Jeong (Kyungpook National University, School of Medicine and Chilgok Hospital, Daegu); Eun Jung Kong (Yeungnam University Medical School and Hospital, Daegu); Keunyoung Kim (Pusan National University, Busan); Byung Il Kim (Korea Institute of Radiological & Medical Sciences, Seoul); Jahae Kim (Chonnam National University Hospital, Gwangju); Heeyoung Kim (Kosin University Gospel Hospital, Busan); Seol Hoon Park and Minjung Seo (Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan); Jisun Park (Inje University Busan Paik Hospital, Busan); Hye Lim Park (Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul); So Won Oh (Seoul National University Boramae Medical Center, Seoul); Kyoung Sook Won (Keimyung University Dongsan Hospital, Daegu); Young Hoon Ryu (Yonsei University Gangnam Severance Hospital, Seoul); Joon-Kee Yoon (Ajou University School of Medicine, Suwon); Soo Jin Lee (Hanyang University Medical Center, Seoul); Jong Jin Lee (Asan Medical Center, University of Ulsan College of Medicine, Seoul); Ari Chong (Chosun University Hospital, Gwangju); Young Jin Jeong (Dong-A University Hospital, Busan); Ju Hye Jeong (Kyungpook National University Hospital, Daegu); Young Seok Cho (Samsung Medical Center, Seoul); Arthur Cho (Yonsei University College of Medicine, Seoul); Gi Jeong Cheon and Seunggyun Ha (Seoul National University College of Medicine, Seoul); Eun Kyoung Choi (Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul); Jae Pil Hwang (Soon Chun Hyang University Bucheon Hospital, Bucheon); and Sang Kyun Bae (Inje University Haeundae Paik Hospital, Busan)

The authors thank Ms. Jayeong Paek, Institute for Biomedical Science CNUHH, for her assistance of statistical analysis.

Funding

This study was supported by the Clinical Trial Network Program of the Korean Society of Nuclear Medicine (KSNM-CTN-2016-01-1).

Author information

Correspondence to Sang Kyun Bae.

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Conflict of interest

The authors declare that they have no conflict of interest.

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

The institutional review board of our institutes approved this retrospective study, and the requirement to obtain informed consent was waived.

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Kwon, S.Y., Lee, S., Kong, E.J. et al. Clinicopathologic risk factors of radioactive iodine therapy based on response assessment in patients with differentiated thyroid cancer: a multicenter retrospective cohort study. Eur J Nucl Med Mol Imaging 47, 561–571 (2020). https://doi.org/10.1007/s00259-019-04634-8

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Keywords

  • Differentiated thyroid carcinoma
  • Radioactive iodine therapy
  • Recombinant human thyrotropin
  • Response to therapy