Radioiodine (131I) treatment decision-making for low- and intermediate-risk differentiated thyroid cancer

Gao, Haiyan; Huang, Jiyuan; Dai, Qingjing; Su, Juan

doi:10.20945/2359-3997000000538

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Archives of Endocrinology and Metabolism

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Original Article • Arch. Endocrinol. Metab. 67 (2) • Mar-Apr 2023 • https://doi.org/10.20945/2359-3997000000538 copy

Radioiodine (131I) treatment decision-making for low- and intermediate-risk differentiated thyroid cancer

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

The purpose of this study was to investigate the effect and influencing factors of post-surgical radioactive iodine (RAI) therapy for patients with low- and intermediate-risk differentiated thyroid cancer (DTC).

Subjects and methods:

A retrospective analysis of 423 low- and intermediate-risk DTC patients admitted to the Department of Nuclear Medicine, Sichuan Provincial People’s Hospital from January 2005 to December 2020 was performed. All patients were treated with surgery, had a postoperative pathological diagnosis, and were treated with RAI, including 89 males and 334 females. Recurrence risk stratification: 143 cases were low-risk, and 280 cases were intermediate-risk.

Results:

The excellent response (ER) rate for low- and intermediate-risk were 93.7% and 78.2%, respectively (P < 0.05). There were significant differences in age, cumulative dose of [¹³¹I], and pretreatment stimulated-Tg (pre-Tg) levels between the low- and intermediate-risk groups (P < 0.05). There were significant differences in the cumulative dose of ¹³¹I and pre-Tg levels between ER and the non-ER group (P < 0.05). The area under the curve (AUC) values were 0.799 in the low-risk group, and 0.747 in the intermediate-risk group for the ROC curve by ER status of pre-Tg. The ER rate with RAI treatment decreased with an increase in pre-Tg levels.

Conclusion:

Pre-Tg was an important factor for RAI treatment decision-making and prognostic evaluation and differed between low-risk and intermediate-risk DTC. Aggressive RAI therapy was recommended for low-risk DTC with pre-Tg ≥ 20.0 ng/mL and in intermediate-risk group with pre-Tg ≥ 10.0 ng/mL.

Keywords
Differentiated thyroid cancer; radioactive iodine [¹³¹I] treatment; low and intermediate-risk

	Risk stratification	Low risk	Intermediate-risk	F	P
Therapy response	ER	134 (93.7%)	219 (78.2%)	16.45	0.000
	IR	1	17
	BIR	7	37
	SIR	1	7
Frequency of RAI	1 dose	129 (90.2%)	188 (67.1%)
	2 doses	12 (8.4%)	68 (24.3%)
	≥3 doses	2 (1.4%)	24 (8.6%)
	Total	143 (100.0%)	280 (100.0%)
ER% in different Pre-Tg (ng/mL) groups	≤1.0	39/40 (97.5%)	55/62 (88.7%)	85.021	0.000
	1.0~10	64/66 (97.0%)	87/96 (90.6%)
	10~20	9/9 (100.0%)	29/37 (78.4%)
	>20	5/10 (50.0%)	15/39 (38.5%)

	Low risk	Intermediate-risk	Total	F	P
N	143	280	423
Age (y)	44.5 ± 13.1	39.2 ± 13.4	41.0 ± 13.6	3.899	0.000^a a Independent-sample t-test.
Frequency of RAI	1.11 ± 0.36	1.45 ± 0.78	1.34 ± 0.69	6.146	0.000^a a Independent-sample t-test.
cumulative dose ¹³¹I(mci)	113.1 ± 46.1	162.4 ± 117.6	145.8 ± 102.0	6.147	0.000^a a Independent-sample t-test.
24 h RAIU(%)	2.9 (1.7,7.9)	3.5 (1.8,6.4)	3.3 (1.7, 6.9)	0.548	0.459^a a Independent-sample t-test.
FT3 (pmol/L)	2.35 ± 0.89	2.30 ± 0.90	2.32 ± 0.89	0.480	0.631^a a Independent-sample t-test.
FT4 (pmol/L)	5.83 ± 1.94	5.87 ± 2.16	5.86 ± 2.09	0.186	0.852^a a Independent-sample t-test.
TSH (mIU/L)	79.8 ±2 8.7	81.9 ± 27.6	81.2 ± 28.0	0.712	0.477^a a Independent-sample t-test.
Tgab (IU/mL)	10.3 (6.13, 25.1)	12.3 (5.0, 22.92)	11.4 (5.2, 23.6)	0.411	0.681^b b Tg. TgAb: nonparametric rank sum test, Mann-Whitney U test. Pre-Tg: pretreatment stimulated-Tg.
Pre-Tg (ng/mL)	2.46 (0.49, 6.78)	3.92 (0.89, 14.2)	3.42 (0.71, 10.6)	2.909	0.004^b b Tg. TgAb: nonparametric rank sum test, Mann-Whitney U test. Pre-Tg: pretreatment stimulated-Tg.
Follow-up (months)	72.7 ± 30.0	69.6 ± 32.6	70.6 ± 31.7	0.942	0.347^a a Independent-sample t-test.

	N stage	N	Mean ± SD	F	P	T stage	N	Mean ± SD	Z	P
Age (year)	N0+Nx	151	44.4 ± 13.1	9.328	0.000	T1	266	41.8 ± 13.2	6.229	0.002
	N1a	111	40.8 ± 13.0			T2	105	37.3 ± 13.6
	N1b	161	37.9 ± 13.6			T3	52	44.4 ± 13.8
Frequency of RAI	N0+Nx	151	1.1 ± 0.4	29.828	0.000	T1	266	1.2 ± 0.4	21.59	0.000
	N1a	111	1.2 ± 0.4			T2	105	1.6 ± 0.9
	N1b	161	1.6 ± 0.9			T3	52	1.6 ± 0.9
Cumulative dose ¹³¹I (mci)	N0+Nx	151	113.8 ± 47.5	28.99	0.000	T1	266	122.2 ± 59.2	20.96	0.000
	N1a	111	124.1 ± 57.7			T2	105	183.8 ± 138.4
	N1b	161	190.7 ± 140.4			T3	52	189.4 ± 145.0
24h RAIU (%)	N0+Nx	151	5.5 ± 5.8	0.87	0.420	T1	265	4.8 ± 5.2	5.226	0.006
	N1a	111	5.0 ± 5.8			T2	104	6.6 ± 6.9
	N1b	159	6.0 ± 6.2			T3	52	7.1 ± 6.8
TSH (mIU/L)	N0+Nx	151	79.7 ± 29.3	0.329	0.720	T1	266	83.3 ± 24.7	3.271	0.039
	N1a	111	82.2 ± 23.5			T2	105	80.1 ± 30.8
	N1b	161	81.9 ± 29.7			T3	52	72.7 ± 35.9
FT3 (pmol/L)	N0+Nx	151	2.4 ± 1.0	2.083	0.126	T1	266	2.20 ± 0.73	8.712	0.000
	N1a	111	2.20 ± 0.67			T2	105	2.45 ± 0.96
	N1b	160	2.37 ± 0.95			T3	51	2.70 ± 1.31
FT4 (pmol/L)	N0+Nx	151	5.91 ± 2.12	0.789	0.455	T1	266	5.59 ± 1.47	6.306	0.002
	N1a	111	5.65 ± 1.65			T2	105	6.27 ± 2.79
	N1b	160	5.96 ± 2.32			T3	51	6.43 ± 2.82
Tgab (IU/mL)	N0+Nx	137	10.27 (5.63,25.11)	3.942	0.139	T1	225	12.75 (5.95,25.6)	5.961	0.051
	N1a	100	13.27 (5.81,28.60)			T2	90	9.40 (4.60,21.95)
	N1b	122	10.73 (4.88,19.78)			T3	44	8.50 (2.52,16.51)
Pre-Tg (ng/mL)	N0+Nx	137	2.55 (0.46,7.45)	20.707	0.000	T1	225	2.21 (0.53,6.70)	27.713	0.000
	N1a	100	2.36 (0.78,6.85)			T2	90	6.78 (1.03,19.78)
	N1b	122	7.34 (1.13,22.05)			T3	44	9.63 (2.96,19.53)

	Pre-Tg (ng/mL)	N	Mean	F	P
Pre-Tg (ng/mL)	≤1.0	102	0.2 (0.20, 0.545)	316.194	0.000
	1.0~10	162	3.51 (2.01, 5.78)
	10~20	46	13.7 (11.48, 15.73)
	>20	49	35.60 (24.50, 84.75)
Frequency of RAI	≤1.0	102	1.1 ± 0.4	15.114	0.000
	1.0~10	162	1.2 ± 0.5
	10~20	46	1.4 ± 0.6
	>20	49	2.1 ± 1.0
Cumulative dose (mci)	≤1.0	102	116.2 ± 46.8	14.287	0.000
	1.0~10	162	125.8 ± 79.5
	10~20	46	147.8 ± 69.1
	>20	49	263.3 ± 164.2
24h RAIU (%)	≤1.0	102	2.3 ± 1.7	37.633	0.000
	1.0~10	162	4.9 ± 4.7
	10~20	46	10.7 ± 8.0
	>20	49	8.8 ± 7.2
Tgab (IU/mL)	≤1.0	102	25.0 (12.25, 50.46)	64.776	0.000
	1.0~10	162	9.60 (4.98, 18.54)
	10~20	46	7.89 (3.23, 14.88)
	>20	49	7.80 (2.50, 13.22)

	ER	N	NER	N	F	P
Age (year)	41.1 ± 13.0	353	40.6 ± 14.7	70	0.243	0.808^a a Independent-sample t-test.
¹³¹I cumulative dose (mci)	125.4 ± 70.7	353	248.6 ± 159.0	70	10.319	0.000^a a Independent-sample t-test.
24h RAIU (%)	5.34 ± 5.79	353	6.52 ± 6.53	70	1.524	0.128^a a Independent-sample t-test.
FT3 (pmol/L)	2.28 ± 0.86	353	2.51 ± 1.04	70	1.991	>0.047^a a Independent-sample t-test.
FT4 (pmol/L)	5.78 ± 1.95	353	6.19 ± 2.65	70	1.190	0.237^a a Independent-sample t-test.
TSH (mIU/L)	81.9 ± 27.1	353	77.9 ± 32.3	70	1.094	0.275^a a Independent-sample t-test.
Tgab (IU/mL)	13.3 (6.6,39.7)	303	15.1 (5.81,46.1)	56	1.725	0.085^b b Tg. TgAb: nonparametric rank sum test, Mann-Whitney U test. Pre-Tg: pretreatment stimulated-Tg.
Pre-Tg (ng/mL)	1.73 (0.34,5.66)	303	2.61 (0.42,11.6)	56	6.295	0.000^b b Tg. TgAb: nonparametric rank sum test, Mann-Whitney U test. Pre-Tg: pretreatment stimulated-Tg.

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[1] Correspondence to: Jiyuan Huang, Department of Nuclear Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section First Ring Road, Chengdu City, Sichuan Province, 610072, China. huangjiyuan88@163.com