Analysis of therapeutic response of iodine positive metastasis lymph nodes in differentiated thyroid cancer after 131I treatment

doi:10.19401/j.cnki.1007-3639.2022.11.007

Abstract

Abstract:

Background and purpose: Lymph node metastasis (LNM) is the most common metastasis of differentiated thyroid cancer (DTC), and the efficacy of ¹³¹I on LNM is controversial. The aim of this study was to clarify the efficacy of ¹³¹I on LNM with good iodine uptake and the influencing factors. Methods: In this study, 161 iodine positive metastasis lymph nodes from 90 DTC patients treated by ¹³¹I from January 2015 to June 2019 in Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine were included, and the clinical and imaging data of the patients were analyzed. SPSS 24.0 software was used to make statistical analysis. The measurement data were distributed according to the normal distribution, then the independent sample t-test was compared. The comparison of the counting data was conducted by χ² test, and the multivariate analysis was carried out by logistic regression analysis. The receiver operating characteristic (ROC) curve between multiple quantitative indexes and the failure of ¹³¹I treatment were established, and the optimal diagnostic threshold was obtained. Results: Among 161 iodine positive metastasis lymph nodes, 71 (44.10%) were effective, and 90 (55.90%) were ineffective. Univariate analysis showed that there were significant differences in age, gender, pathological type, number of primary lesions, location of primary lesions, distant metastasis and serum thyroglobulin (Tg) level between the two groups (P<0.05). Multivariate logistic regression analysis showed that the pathological types (OR = 11.827, 95% CI: 1.128-123.978, P = 0.039), distant metastasis (OR = 0.220, 95% CI: 0.093-0.522, P = 0.001) and number of primary lesions (OR = 0.421, 95% CI: 0.212-0.837, P = 0.014) were closely related to the outcome of the treatment. Conclusion: Multiple primary foci, papillary thyroid carcinoma (PTC), distant metastasis, serum Tg higher than 43.51 ng/mL and the maximum diameter of metastatic lymph nodes greater than 16.8mm are the risk factors of ineffective ¹³¹I treatment. Increasing the treatment dose or choosing surgical resection as soon as possible is recommended for those patients.

Key words: Differentiated thyroid cancer, Iodine positive, Lymph node metastasis, Efficacy analysis

CLC Number:

R736.1

MEI Xiaoran, FENG Fang, WANG Hui, WEI Zhixiao. Analysis of therapeutic response of iodine positive metastasis lymph nodes in differentiated thyroid cancer after ¹³¹I treatment[J]. China Oncology, 2022, 32(11): 1091-1097.

Figures/Tables 4

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References 22

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Characteristic	¹³¹I effective	¹³¹I ineffective	P value	Characteristic	¹³¹I effective	¹³¹I ineffective	P value
Female n	44	42	0.101	N_1b	32	56
Median age/year	46.63	42.94	0.056	Unknown	2	5
Age/year n			0.039	M stage n			<0.001
≥45	47	45		M₀	9	35
<45	24	45		M₁	62	55
Interval time/month x±s	2.01±1.27	2.33±1.49	0.291	Tg/(ng·mL^-1) x±s	121.41±247.27	341.17±377.94	<0.001
Histology n			0.023	TSH/(U·L^-1) x±s	70.12±53.46	68.71±44.43	0.867
PTC	65	89		Pathological LNM number x±s	6.82±6.75	8.75±8.33	0.145
FTC	6	1		LNM number in PET/CT n			0.679
Number of lesions n			0.044	Single LNM	25	29
Single lesion	38	29		Multiple LNMs	45	60
Multiple lesions	32	61		LNM location in PET/CT n			0.640
Tumor size/cm x±s	2.30±1.30	2.41±1.37	0.656	N_1a	14	15
Tumor location n			0.015	N_1b	57	74
Unilateral thyroid	37	30		Median maximum LNM diameter in PET/CT n	13.62	15.02	0.227
Bilateral thyroid	33	59		SUV_maxx±s	3.23±152	3.78±7.87	0.621
Unknown	1	1		Immunohistochemistry n
Local invasion (+) n	18	23	0.977	Tg	16	6	0.471
Margin carcinoma (+) n	53	67	0.866	TTF1	12	6	0.471
Pathological N stage n			0.344	P53	24	11	0.523
N₀	12	12		Galectin 3	8	4	0.366
N_1a	21	21

Covariable	OR (95% CI)	P value
Gender: female/male	1.446 (0.746-2.880)	0.267
Age: per year	1.013 (0.99-1.036)	0.280
Histology: PTC/FTC	11.827 (1.128-123.978)	0.039
Number of lesions: multiple lesions/single lesion	0.421 (0.212-0.837)	0.014
Stage: M₁/ M₀	0.220 (0.093-0.522)	0.001

Analysis of therapeutic response of iodine positive metastasis lymph nodes in differentiated thyroid cancer after ¹³¹I treatment

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