방사선의학 웹진

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Abstract
Purpose: Radioactive iodine therapy (RAI) ≥100 mCi (3.7 GBq) is commonly recommended for papillary thyroid cancer (PTC) patients with extranodal extension (ENE). However, no study has evaluated whether RAI ≥100 mCi is effective in reducing the recurrence of PTC with ENE.

Methods: This retrospective cohort study enrolled 191 PTC patients with ENE who underwent total thyroidectomy and RAI. Recurrence according to RAI activity (<100 vs. ≥100 mCi) was compared before and after propensity score matching (PSM) (1:2) using Kaplan-Meier curves and Cox proportional hazards regression models. Subgroup analyses according to mass size (<4 and ≥4 cm), gender, blood vessel invasion, lymph node (LN) number (≤5 and >5), and stimulated Tg (sTg) level (<10 and ≥10 ng/mL) before and after PSM were performed.

Results: During about 116 months, 5 (12.5%) and 19 (12.6%) before PSM, five (12.5%) and 3 (3.8%) after PSM recorded recurrence in <100 and ≥100 mCi groups, respectively. The impact of RAI ≥100 mCi on reducing recurrence was not significant before [log-rank P = 0.915, adjusted hazard ratio (HR) 0.49 (0.12-1.85); P = 0.294) and after PSM (log-rank P = 0.077). Subgroup analysis after PSM demonstrated the impact of RAI ≥100 mCi on lowering recurrence only in ENE patients with mass size ≥4 cm (log-rank P = 0.008), LN >5 (log-rank P = 0.007), and sTg ≥10 ng/mL (log-rank P = 0.039).

Conclusions: In PTC patients with ENE, mass size ≥4 cm, LN >5, or sTg ≥10 ng/mL had a benefit from RAI ≥100 mCi compared with RAI <100 mCi.

종양 크기(≥4cm), 전이된 림프절 수(>5개), 자극성 티로글로불린 수치(≥10ng/mL) 가 높은 환자군에서 고용량 치료 효과 확인

Affiliations

Hye In Kim 1, Boram Kim 2, Jiyeon Hyeon 3, Nak Gyeong Ko 4, Mihyeon Jin 4, Jung Hwan Cho 1, Ji Min Han 1, Sunghwan Suh 1, Ji Cheol Bae 1, Man Ki Chung 5, Jun-Ho Choe 6, Sun Wook Kim 2, Jae Hoon Chung 2, Young Lyun Oh 3, Kyunga Kim 7, Tae Hyuk Kim 2, Joon Young Choi 8
1Department of Medicine, Division of Endocrinology and Metabolism, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon.
2Department of Medicine, Division of Endocrinology & Metabolism, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine.
3Department of Medicine, Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
4Department of Research & Support, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon.
5Department of Otorhinolaryngology-Head and Neck Surgery.
6Department of Surgery, Division of Breast and Endocrine Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
7Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center.
8Department of Nuclear Medicine, and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.