Impact factors for the outcome of the first ¹³¹I radiotherapy in patients with papillary thyroid carcinoma after total thyroidectomy

Objective

To investigate the impact factors of the outcome of the first ¹³¹I treatment in patients with papillary thyroid carcinoma (PTC) after total thyroidectomy.

Methods

Three hundred and fifty-three patients [256 females, 97 males, average age (43.58 ± 12.33 years)] with PTC after total thyroidectomy who underwent ¹³¹I treatment from July 2014 to August 2017 were retrospectively analyzed. Curative efficacy of ¹³¹I treatment was assessed 6 months afterward. Therapeutic outcome was determined according to thyrotropin (TSH)-stimulated thyroglobulin (sTg) level, ¹³¹I diagnostic whole-body scan (Dx-WBS) after ¹³¹I treatment and other imaging modalities. Twelve possible factors affecting the therapeutic outcome of ¹³¹I treatment including patients' gender, age, interval between surgery and ¹³¹I treatment, primary tumor size and extrathyroidal extension (ETE), number and range of primary tumor lesions, result of ^99mTcO₄⁻ thyroid scan, number of metastatic lymph nodes (LN), pre-treatment laboratory measurements [TSH, sTg and Tg antibody (TgAb)], therapeutic dose of ¹³¹I and result of ¹³¹I post-treatment whole-body scan (Rx-WBS) were analyzed using univariate and multivariate logistic regression. The receiver operator characteristic (ROC) curve and diagnostic cutoff value were analyzed to evaluate the predictive value of the significant quantitative impact factors for the outcome of ¹³¹I treatment.

Results

The curative rate of the first ¹³¹I treatment in patients with PTC after total thyroidectomy was 62.32% (220/353). Univariate analysis indicated that gender, age, number and range of primary tumor lesions, number of metastatic LN, pre-treatment sTg and TgAb, therapeutic dose of ¹³¹I and result of ¹³¹I Rx-WBS (all P < 0.05) were significant factors affecting the outcome of ¹³¹I treatment. Multivariate analysis revealed that the numbers of metastatic LN (regression coefficient = 1.170) and sTg (regression coefficient = 0.280) were significant impact factors (all P < 0.001). The regression equation was: Logit P = − 3.997 + 1.170 × number of metastatic LN + 0.280 × sTg (χ² = 210.68, P < 0.001). Taking sTg as a predictive factor for the outcome of the first ¹³¹I treatment, the area under the curve (AUC) of ROC for sTg was 0.917 (95% CI 0.890–0.944). The cutoff value of sTg was 2.69 ng/mL with a sensitivity of 92.48% (123/133) and specificity of 74.09% (163/220).

Conclusion

Patients with PTC after total thyroidectomy with low pre-treatment sTg level and few lymph node metastases are more likely to be cured by the first ¹³¹I treatment.