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Stimulated thyroglobulin and thyroglobulin reduction index predict excellent response in differentiated thyroid cancers
Barres, Bertrand Kelly, Antony Kwiatkowski, Fabrice Batisse-Lignier, Marie Fouilhoux, Geneviève Aubert, Bernadette Dutheil, Frederic Tauveron, Igor Cachin, Florent Maqdasy, Salwan
Barres, Bertrand
Kelly, Antony
Kwiatkowski, Fabrice
Batisse-Lignier, Marie
Fouilhoux, Geneviève
Aubert, Bernadette
Dutheil, Frederic
Tauveron, Igor
Cachin, Florent
Maqdasy, Salwan
Abstract
Context Despite its good prognosis, differentiated thyroid cancer (DTC) is characterized by high rates of disease persistence and recurrence. Estimation of long-term remission (excellent response) thanks to specific parameters could help to individualize the active surveillance schedule. Objective Evaluation of the ability of stimulated thyroglobulin (Tg) and Tg reduction index (TRI) to predict long-term remission in patients with DTC managed by thyroidectomy and radioactive iodine (RAI) remnant ablation. Patients and Interventions Observational retrospective study of 1093 patients treated for DTC between 1995 and 2010. Preablation stimulated thyroglobulin (presTg) was measured under thyroid hormone withdrawal just before RAI. Recombinant human TSH–stimulated thyroglobulin (sTg) was measured at first evaluation of the initial management 6 to 12 months after RAI. TRI was calculated based on pre-Tg and sTg. Results After univariate and multivariate analyses, lymph node invasion (N1, OR = 2.08; 95% CI, 1.19 to 3.64), presTg (OR = 4.04; 95% CI, 2.56 to 6.38), sTg (OR = 2.62; 95% CI, 2.05 to 3.34), and TRI (OR = 0.43; 95% CI, 0.21 to 0.88) were identified as independent prognostic factors influencing the rate of disease persistence or recurrence after the initial management. Receiver operating characteristic analysis identified presTg cutoff (<10 µg/L) to predict excellent response, with a negative predictive value of 94%, and validated for higher stages (T3/T4, N1). Furthermore, sTg <1 µg/L predicts excellent response. TRI >60% for the entire cohort and 62.5% for locally advanced disease (T3/T4, N1) was sensitive predictor for excellent response. Conclusion This study identifies presTg, sTg, and TRI as highly sensitive predictors of excellent response in patients with DTC and subsequently disease-free status. The cutoff of such parameters is also adapted for patients with higher tumor stages (T3/T4, N1).
Keywords
differentiated thyroid cancer (DTC)
Date
2019
Type
Journal article
Journal
The Journal of Clinical Endocrinology and Metabolism
Book
Volume
104
Issue
8
Page Range
3462-3472
Article Number
ACU Department
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Open Access Status
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Controlled