방사선의학 웹진

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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.

그림 1. 환자 선택 흐름도

그림 2. 평가기준에 따른 반응의 분포. a. 생화학검사와 목초음파 검사를 이용한 평가결과. b. 생화학검사, 목초음파 검사, 방사성요오드 스캔을 이용한 평가 결과.

Author information

Kwon SY1, Lee SW2, Kong EJ3, Kim K4, Kim BI5, Kim J6, Kim H7, Park SH8, Park J9, Park HL10, Oh SW11, Won KS12, Ryu YH13, Yoon JK14, Lee SJ15, Lee JJ16, Chong A17, Jeong YJ18, Jeong JH19, Cho YS20, Cho A21, Cheon GJ22, Choi EK23, Hwang JP24, Bae SK25; Korean Society of Nuclear Medicine (KSNM) Thyroid Cancer Clinical Trial Network (CTN) Retrospective Cohort Study Group.
1
Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeonnam, Republic of Korea.
2
Department of Nuclear Medicine, School of Medicine and Chilgok Hospital, Kyungpook National University, Daegu, Republic of Korea.
3
Department of Nuclear Medicine, Yeungnam University Medical School and Hospital, Daegu, Republic of Korea.
4
Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University, Busan, Republic of Korea.
5
Department of Nuclear Medicine, Korea Institute of Radiological & Medical Sciences, Seoul, Republic of Korea.
6
Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
7
Department of Nuclear Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea.
8
Department of Nuclear Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
9
Department of Nuclear Medicine, Inje University Busan Paik Hospital, Busan, Republic of Korea.
10
Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
11
Department of Nuclear Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
12
Department of Nuclear Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea.
13
Department of Nuclear Medicine, Yonsei University Gangnam Severance Hospital, Seoul, Republic of Korea.
14
Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Republic of Korea.
15
Department of Nuclear Medicine, Hanyang University Medical Center, Seoul, Republic of Korea.
16
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
17
Department of Nuclear Medicine, Chosun University Hospital, Gwangju, Republic of Korea.
18
Department of Nuclear Medicine, Dong-A University Hospital, Busan, Republic of Korea.
19
Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
20
Department of Nuclear Medicine, Samsung Medical Center, Seoul, Republic of Korea.
21
Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
22
Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
23
Division of Nuclear Medicine, Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
24
Department of Nuclear Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Republic of Korea.
25
Department of Nuclear Medicine, Inje University Haeundae Paik Hospital, Busan, Republic of Korea. sbae@inje.ac.kr.

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