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Prognostic disparities between radioactive iodine-refractory and non-refractory DTC patients: a cohort study on
Menghua Xia1, Weifu Lv2, Wei Zhao1
1Department of Nuclear Medicine, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, P.R. China.
Aims:
Patients with distant metastases of differentiated thyroid cancer (DM-DTC) exhibit significant heterogeneity in clinical characteristics and prognosis. This study aimed to investigate prognostic variables affecting overall survival (OS) in radioiodine-refractory (RAIR) patients and to predict the radioiodine therapy (RAIT) response and stimulated thyroglobulin (sTg) levels in non-radioiodine-refractory (NRAIR) patients.
Methods:
A retrospective analysis was conducted on 146 patients of DM-DTC undergoing RAIT, categorizing them into an RAIR group (n = 56) and an NRAIR group (n = 90). Kaplan-Meier assessed survival, Cox regression identified RAIR prognostic factors, and logistic regression explored sTg-treatment response in NRAIR.
Results:
The median follow-up period was 71 months (IQR: 24-132 months).In RAIR, brain metastasis (HR = 5.49, 95% CI: 1.46-20.66, p = 0.012) and other-site metastases (HR = 4.11, 95% CI: 1.06-15.85, p = 0.004) were independent poor prognostic factors. In NRAIR, sTg ≤ 75 ng/mL predicted favorable response (sensitivity 84.8%, specificity 78.9%).
Conclusions:
RAIR status significantly impacts DM-DTC prognosis. Brain metastases or other-site metastases are independent prognostic factors in RAIR patients, highlighting the need for stratified treatment. In NRAIR patients, preliminary data suggest that sTg ≤ 75 ng/mL predicts a favorable treatment response.
