The first postoperative-stimulated serum thyroglobulin is a prognostic factor for thyroid microcarcinomas

Amui, Isabela de Oliveira; Tagliarini, José Vicente; Castilho, Emanuel C.; Marques, Mariângela de Alencar; Kiy, Yoshio; Corrente, José Eduardo; Mazeto, Gláucia M.F.S.

doi:10.1016/j.bjorl.2017.10.005

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Brazilian Journal of Otorhinolaryngology

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Original articles • Braz. j. otorhinolaryngol. 85 (1) • Jan-Feb 2019 • https://doi.org/10.1016/j.bjorl.2017.10.005 copy

The first postoperative-stimulated serum thyroglobulin is a prognostic factor for thyroid microcarcinomas^☆ ☆ Please cite this article as: Amui IO, Tagliarini JV, Castilho EC, Marques MA, Kiy Y, Corrente JE, et al. The first postoperative-stimulated serum thyroglobulin is a prognostic factor for thyroid microcarcinomas. Braz J Otorhinolaryngol. 2019;85:37-42.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Endogenous thyroid-stimulating hormone-stimulated thyroglobulin collected after total thyroidectomy is a useful predictor of better prognosis in patients with differentiated thyroid carcinomas in general, but studies with microcarcinomas are scarce.

Objective:

To assess whether the first postoperative stimulated thyroglobulin measurement is a prognostic factor in patients with microcarcinoma.

Methods:

The medical data of 150 differentiated thyroid carcinoma patients were studied retrospectively, and 54 (36%) cases with microcarcinoma were selected. The first postoperative stimulated thyroglobulin (1st stimulated thyroglobulin), measured after thyroidectomy, initial presentation data, and microcarcinomas treatment were assessed regarding outcome. Worse prognosis was defined as neoplasm persistence/recurrence.

Results:

Persistence/recurrence occurred in 27.8% of the cases. These patients were identified according to the following parameters: receiving more than one ¹³¹iodine dose (100% vs. 0%; p < 0.0001); accumulated ¹³¹iodine dose (232.14 ± 99.09 vs. 144 ± 33.61 mCi; p < 0.0001); presented active disease in the last assessment (53.3% vs. 0%; p < 0.0001); follow-up time (103.07 ± 61.27 vs. 66.85 ± 70.14 months; p = 0.019); and 1st stimulated thyroglobulin (19.01 ± 44.18 vs. 2.19 ± 2.54 ng/dL; p < 0.0001). After multivariate logistic regression, only the 1stSTg [odds ratio = 1.242; 95% confidence interval: 1.022-1.509; p = 0.029] and follow-up time (odds ratio = 1.027; 95% confidence interval: 1.007-1.048; p = 0.007) were independent predictors of risk of persistence/recurrence. The cutoff point of 1.6 ng/dL for the 1st stimulated thyroglobulin was significantly associated with disease persistence/recurrence [area under the curve = 0.713 (p = 0.019)].

Conclusion:

The first stimulated thyroglobulin predicted disease persistence/recurrence in patients with microcarcinoma.

KEYWORDS
Biological markers; Clinical evolution; Prognosis; Thyroglobulin; Thyroid neoplasms

General data
Female, n (%) ^a a Frequencies and percentages for categorical variables.	48 (88.9)
White reported color, n (%) ^a a Frequencies and percentages for categorical variables.	53 (98.2)
Age (years) ^b b Mean ± standard deviation.	46.30 ± 13.58
Follow-up (months) ^b b Mean ± standard deviation.	76.91 ± 69.19
Total thyroidectomy, n (%) ^a a Frequencies and percentages for categorical variables.
One stage	33 (61.1)
Two stages	21 (38.9)
Lymph node dissection, n (%) ^a a Frequencies and percentages for categorical variables.	16 (29.6)
Histological subtypes, n (%) ^a a Frequencies and percentages for categorical variables.
Papillary carcinoma
Classic	41 (75.9)
Follicular variant	8 (14.8)
Sclerosing	1 (1.8)
Mucinous	1 (1.8)
Columnar cells	1 (1.8)
Oncocytic cells	1 (1.8)
Follicular	1 (1.8)
Tumor size (cm) ^b b Mean ± standard deviation.	0.61 ± 0.30
Multifocality, n (%) ^a a Frequencies and percentages for categorical variables.	20 (37.0)
Bilaterality, n (%) ^b b Mean ± standard deviation.	15 (27.8)
Tumor capsule, n (%) ^a a Frequencies and percentages for categorical variables.
Complete	13 (24.1)
Incomplete	8 (14.8)
Absent	33 (61.1)
Lymph node metastases, n (%)^a a Frequencies and percentages for categorical variables.	7 (13)
TNM staging, n (%) ^a a Frequencies and percentages for categorical variables.
I	44 (81.5)
III	1 (1.8)
IV	9 (16.7)
1st whole body scan positive, n (%) ^a a Frequencies and percentages for categorical variables.	51 (94.4)
1st Thyroglobulin stimulated (ng/dL) ^b b Mean ± standard deviation.	6.72 ± 23.6
Number of doses of 131 Iodine, n (%) ^a a Frequencies and percentages for categorical variables.
0	1 (1.9)
1	44 (81.5)
2	8 (14.8)
3	1 (1.9)
Iodine uptake (%) ^b b Mean ± standard deviation.	1.51 ± 1.65
Cumulative dose of 131 Iodine (mCi) ^b b Mean ± standard deviation.	167.79 ± 69.84
Recurrence, n (%) ^a a Frequencies and percentages for categorical variables.	5 (9.3)
Persistence/recurrence, n (%) ^a a Frequencies and percentages for categorical variables.	15 (27.8)
Active disease in the last medical evaluation, n (%) ^a a Frequencies and percentages for categorical variables.	8 (14.8)
Disease-free survival (months) ^b b Mean ± standard deviation.	42.06 ± 65.03

General data	Persistence/recurrence of the disease		p
	No n = 39 (72.2%)	Yes n = 15 (27.8%)
Age (years)	44.87 ± 13.19	50.00 ± 14.32	0.217
Female, n (%)	36 (92.3)	12 (80.0)	0.197
Total thyroidectomy in two stages, n (%)	15 (38.5)	6 (40.0)	0.917
Lymph node dissection, n (%)	10 (25.6)	6 (40.0)	0.301
Tumor size (cm)	0.63 ± 0.29	0.57 ± 0.33	0.618
Multifocality, n (%)	15 (38.5)	5 (33.3)	0.727
Bilaterality, n (%)	11 (28.2)	4 (26.7)	0.946
Classic papillary carcinoma, n (%)	31 (79.5)	10 (66.7)	0.324
Encapsulated tumor, n (%)	8 (20.5)	5 (33.3)	0.324
Invasion of tumor capsule, n (%)	4 (10.3)	3 (20.0)	0.306
Lymph node metastases, n (%)	5 (12.8)	2 (13.3)	0.960
Contralateral lymph node metastases, n (%)	2 (5.1)	2 (13.3)	0.147
TNM III/IV, n (%)	8 (20.5)	2 (13.3)	0.543
1st thyroglobulin stimulated (ng/dL)	2.19 ± 2.54	19.01 ± 44.18	<0.0001
¹³¹Iodine uptake (%)	1.57 ± 1.65	1.36 ± 1.45	0.687
1st whole body scan positive, n (%)	36 (92.3)	15 (100.0)	0.269
Cumulative dose of ¹³¹Iodine (mCi)	144.08 ± 33.61	232.14 ± 99.09	<0.0001
Follow-up (months)	66.85 ± 70.14	103.07 ± 61.27	0.019
Two or more doses of ¹³¹Iodine, n (%)	0 (0.0)	9 (60.0)	<0.0001
Disease-free survival (months)	39.44 ± 69.56	48.87 ± 52.97	0.116
Active disease in the last evaluation, n (%)	0 (0.0)	8 (53.3)	<0.0001

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[1] * Corresponding author. E-mail:gmazeto@fmb.unesp.br (G.M. Mazeto).