Purpose This study conducted a propensity score matching (PSM) analysis to investigate whether radioactive iodine therapy (RAIT) is effective in reducing the recurrence of intermediate-risk papillary thyroid cancer (PTC) with low thyroglobulin (Tg) levels. Methods In total, 1487 intermediate-risk PTC patients with unstimulated Tg ≤ 1 ng/mL or stimulated Tg ≤ 10 ng/mL after total thyroidectomy were enrolled retrospectively. The clinicopathological characteristics were compared between the non-RAIT and RAIT groups before and after PSM (1:4 matching). The impact of RAIT on biochemical recurrence and structural recurrence was evaluated. Results Overall, 1349 (90.7%) patients underwent RAIT, and 138 (9.3%) did not. After a median follow-up time of 51 months, 30 patients presented with recurrence, including 11 structural and 19 biochemical recurrences. After PSM, compared to the RAIT group, the non-RAIT group had a higher rate of structural recurrence (5/138 vs. 5/552, P = 0.046) and biochemical recurrence (6/138 vs. 4/552, P = 0.005). Multivariate analysis showed that not receiving RAIT was an independent risk factor for structural recurrence (HR: 10.572, 95% CI: 2.439-45.843, P = 0.002) and biochemical recurrence (HR: 16.568, 95% CI: 3.670-74.803, P < 0.001). Kaplan-Meier analysis showed that non-RAIT group had more unfavorable RFS (structural and biochemical, all P < 0.05). Conclusions RAIT could decrease the recurrence risk of intermediate-risk PTC in patients with unstimulated Tg ≤ 1 ng/mL or stimulated Tg ≤ 10 ng/mL. Further prospective randomized studies are needed to confirm these findings.
Purpose Few studies have explored radioactive iodine-refractory (RAIR) disease in child, adolescent, and young adult (CAYA) patients with papillary thyroid cancer (PTC). This study systematically investigated the clinicopathologic characteristics and prognosis of CAYA-PTC with RAIR disease. Methods Sixty-five PTC patients aged ≤ 20 years were enrolled in this study, and all patients were confirmed to have pulmonary metastases. Clinicopathological profiles were compared between the radioactive iodine-avid (RAIA) and RAIR groups. Univariate and multivariate regression analyses were performed to identify risk factors for RAIR status and progressive disease (PD). Gene alterations were detected in seventeen patients. Results Overall, 20 patients were included in the RAIR group, accounting for 30.8% (20/65) of the total patients. No significant difference in pathological characteristics was observed between patients aged < 15 years and patients aged 15-20 years, while the younger were more likely to develop the RAIR disease (HR: 3.500, 95% CI: 1.134-10.803, P = 0.023). RET fusions were the most common genetic alterations in CAYA-PTC, but an association with RAIR disease was not detected (P = 0.210). RAIR disease (HR: 10.008, 95% CI: 2.427-41.268, P = 0.001) was identified as an independent predictor of PD. The KM curve revealed a lower progression-free survival (PFS) and disease-specific survival (DSS) rate in the RAIR group than in the RAIA group (P < 0.001 and P = 0.039). Likewise, RAIR disease was a risk factor for unfavorable PFS in patients aged < 15 years (P < 0.001). Conclusion RAIR disease occurs in one-third of CAYA-PTC patients with pulmonary metastases. Younger patients (aged < 15 years) are more susceptible to RAIR status, which leads to unfavorable PFS and DSS.
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