Blood Profiles in the Prediction of Radioiodine Refractory Papillary Thyroid Cancer: A Case–Control Study

Abstract

Purpose Although most patients with papillary thyroid cancer can be cured by surgery and I-131 ablation, a small proportion will progress to radioactive iodine refractory (RAIR) thyroid cancer. The prediction of RAIR in its early stages can improve patient prognosis. The aim of this article is to evaluate the blood biomarkers in patients with RAIR and to establish a prediction model. Patients and Methods Data collected from patients with thyroid cancer that were enrolled from Jan. 2017 to Dec. 2021 were screened. RAIR was defined based on the criteria in the 2015 American Thyroid Association guidelines. The blood biomarkers from the study participants at three admissions timepoints (surgery and first and secondary I-131 ablations) were compared using both parametric and nonparametric tests to identify predictive factors for RAIR. Binary logistic regression analysis was used to construct a prediction model using parameters associated with surgical procedure decision. The model was then assessed with receiver operating characteristic curves. Results Thirty-six patients were included in the data analysis. Sixteen blood variables, including the low density lipoprotein-cholesterol-total cholesterol ratio, neutrophils, thyroglobulins, thyroglobulin antibody, thyroid peroxidase antibody, anion gap, etc., were revealed to be predictors for RAIR. The prediction model, which incorporated two parameters, reached an area under the curve of 0.861 ( p <0.001). Conclusion Conventional blood biomarkers can be used in the prediction of early-stage RAIR. In addition, a prediction model incorporating multiple biomarkers can improve the predictive accuracy.

The Relationship between Oxidative Status and Radioiodine Treatment Qualification among Papillary Thyroid Cancer Patients

“…In our recent study on serum malondialdehyde concentration in PTC patients undergoing RAI, increased oxidative stress was demonstrated throughout the treatment procedure [18][19][20]. It has also been suggested that blood markers can predict early-stage RAI refractory PTC [21][22][23][24][25][26]. Our hypothesis was that there must be a relationship between oxidative stress and both the presence of PTC and distinct clinical management, including RAI.…”

Characteristics and immune checkpoint status of radioiodine-refractory recurrent papillary thyroid carcinomas from Ukrainian Chornobyl Tissue Bank donors

“…The BRAF V600E mutation has been claimed to be a risk factor for recurrent RAI-R metastases of PTC in a number of studies ( 12 , 16 , 44 , 45 ). In our previous work, we also obtained similar results in subjects exposed to radiation in childhood who lived in the northern regions of Ukraine most affected by the Chornobyl accident ( 38 ).…”

“…Furthermore, 5-15% of differentiated thyroid carcinomas may be insensitive to RAI therapy (8)(9)(10). The RAI-refractory (RAI-R) tumors may be a life-threatening condition reducing a 5-year disease-specific survival rate to 60-70% (11,12), and a 10-year survival rate to as low as 10-20% for patients with RAI-R metastatic malignancies (6,(13)(14)(15)(16).…”

“…The RAI-R recurrent PTCs occur more often in elderly patients who have the most unfavorable prognosis (16)(17)(18)(19). Young and middle-aged patients (< 45 years old) have a better overall survival (19), but data on the frequency of RAI-R recurrent PTC in patients of this age with a history of radiation exposure in childhood, and clinicopathological characteristics of primary tumors, primary metastases and recurrent metastases are poorly described.…”