How reliable is secondary risk stratification with stimulated thyroglobulin in patients with differentiated thyroid carcinoma?

J. Lemb; M. Hüfner; B. Meller; K. Homayounfar; C. Sahlmann; J. Meller

doi:10.3413/Nukmed-0517-12-07

Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 2013; 52(03): 88-96
DOI: 10.3413/Nukmed-0517-12-07

Original article

Schattauer GmbH

How reliable is secondary risk stratification with stimulated thyroglobulin in patients with differentiated thyroid carcinoma?

Results from a retrospective studyWie verlässlich ist die sekundäre Risikostratifizierung mittels stimulierten Thyreoglobulins bei Patienten mit differenziertem Schilddrüsen-karzinom?Ergebnisse einer retrospektiven Analyse

J. Lemb

¹Department of Nuclear Medicine, University Medical Center Göttingen, Georg-August-Universität, Germany

,

M. Hüfner

²Department of Internal Medicine, University Medical Center Göttingen, Georg-August-Universität, Germany

,

B. Meller

¹Department of Nuclear Medicine, University Medical Center Göttingen, Georg-August-Universität, Germany

,

K. Homayounfar

³Department of General Surgery, University Medical Center Göttingen, Georg-August-Universität, Germany

,

C. Sahlmann

¹Department of Nuclear Medicine, University Medical Center Göttingen, Georg-August-Universität, Germany

,

J. Meller

¹Department of Nuclear Medicine, University Medical Center Göttingen, Georg-August-Universität, Germany

› Institutsangaben

Abstract

Summary

Objective: Primary risk factors in patients with differentiated thyroid carcinoma (DTC) are well established. In our institution, secondary risk stratification has been performed with stimulated Thyroglobulin (sTg; TSH > 30 mIU/l) within six months after primary therapy since 2001. In this study, we evaluated the predictive value of sTg for long-term disease- free survival (DFS). Patients, methods: Data of 202 consecutive patients with DTC were analyzed retrospectively. Median follow-up time was 6.4 years (12 months to 16.2 years). Patients were staged according to Union International Contre le Cancer (UICC) criteria. Primary risk stratification was carried out according to European Thyroid Association criteria. Initially, 134 patients (66%) were classified as low-risk and 68 patients (34%) as high-risk. The influence of established risk factors and sTg on DFS was analyzed at three different time points, up to 36 months after initial therapy. Results: In total, 169 (84%) of all patients remained in complete remission after surgery followed by radioiodine-therapy. Six patients (3%) developed tumour recurrence after initial complete remission. Primary risk factors for persistent disease were male sex, follicular or oncocytic tumour, primary tumour > 4 cm in diameter, initial lymph node involvement, initial metastatic disease and microscopic or macroscopic residual tumor. sTg ≤ 0.3 ng/ml measured within six months after initial therapy was a highly significant predictor (p ≤ 0.001) for lasting DFS, 99% of patients with sTg ≤ 0.3 ng/ml were in complete remission 36 months after initial therapy. Conclusions: A stimulated Tg ≤ 0.3 ng/ml within six months after initial therapy is a reliable predictor for long-term disease- free survival independent of primary risk stratification.

Zusammenfassung

Ziel: Die primären Risikofaktoren bei Patienten mit differenziertem Schilddrüsenkarzinom (DTC) sind im klinischen Alltag gut etabliert. Seit 2001 wurde in unserer Abteilung innerhalb von sechs Monaten nach primärer Therapie eine sekundäre Risikostratifizierung durch die Bestimmung des stimulierten Thyreo globulins (sTg; TSH > 30 mIU/l) durchgeführt. Das Ziel dieser Studie war es, den prädiktiven Wert des sTg für das langfristige krankheitsfreie Überleben (DFS) zu bestimmen. Patienten, Methoden: Die Daten von 202 konsekutiven Patienten mit DTC wurden retrospektiv analysiert. Der mediane Nachsorgezeitraum betrug 6,4 Jahre (12 Monate bis 16,2 Jahre). Das initiale Staging wurde gemäß den Leitlinien der Union International Contre le Cancer (UICC) und die primäre Risikostratifizierung nach den Leitlinien der European Thyroid Association (ETA) durchgeführt. Initial wurden 134 Patienten (66%) als low-risk und 68 Patienten (34%) als high-risk eingestuft. Der Einfluss etablierter Risikofaktoren und des sTg auf das DFS wurden zu drei verschiedenen Zeitpunkten bis 36 Monate nach initialer Therapie untersucht. Ergebnisse: 169 Patienten (84%) blieben nach chirurgischer Therapie und Radioiodablation in kompletter Remission. Sechs Patienten (3%) entwickelten nach initial kompletter Remission Rezidive. Primäre Risikofaktoren für die Rezidiventwicklung waren männliches Geschlecht, follikulärer oder onko zytärer Tumor, Primärtumor > 4 cm im Durchmesser, initialer Lymphknotenbefall, initiale Metastasen sowie ein mikroskopischer oder makroskopischer Resttumor. Ein sTg ≤ 0,3 ng/ml innerhalb von sechs Monaten nach initialer Therapie war ein hochsignifikanter Prädiktor (p < 0,001) für dauerhaftes DFS. 99% der Patienten mit einem sTg ≤ 0,3 ng/ml waren auch 36 Monate nach initialer Therapie noch in kompletter Remission, während 71% der Patienten, deren sTg sechs Monate nach initialer Therapie ≥ 50 ng/ml betrug, auch 36 Monate nach Therapie nicht in Remission waren. Schlussfolgerung: Ein sTg ≤ 0,3 ng/ml innerhalb von sechs Monaten nach initialer Therapie ist – unabhängig von der primären Risikostratifizierung – ein verlässlicher Prädiktor für langfristiges krankheitsfreie Überleben.

Keywords

Differentiated thyroid carcinoma - follow-up - secondary risk stratification - stimulated thyroglobulin

Schlüsselwörter

Differenziertes Schilddrüsenkarzinom - Nachsorge - sekundäre Risikostratifizierung - stimuliertes Thyreoglobulin

Volltext

Referenzen

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