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Survival benefit of postoperative radioiodine therapy among patients with intermediate-risk differentiated thyroid carcinoma

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Abstract

Background

The 2015 American Thyroid Association (ATA) guidelines proposed the use of the ATA Risk Stratification System and American Joint Committee on Cancer Tumor-Node-Metastasis (AJCC/TNM) Staging System for postoperative radioiodine decision-making. However, the management of patients with intermediate-risk differentiated thyroid carcinoma (DTC) is not well defined. In this study, we aimed to evaluate the therapeutic efficacy of radioactive iodine therapy (RAIT) among various subgroups of patients with intermediate-risk DTC after surgery.

Methods

This was a retrospective study based on the Surveillance, Epidemiology, and End Results (SEER) database (2010–2015). The DTC patients with intermediate risk of recurrence were divided into two groups (treated or not treated with radioactive iodine (RAI)). As the treatment was not randomly assigned, stabilized inverse probability treatment weighting (sIPTW) was used to reduce selection bias. We used the Kaplan-Meier method and log-rank test to analyze overall survival (OS) and cancer-specific survival (CSS).

Results

Kaplan-Meier analysis after sIPTW found a significant difference in OS and CSS between no RAIT and RAIT (log-rank test, P < 0.0001; P = 0.0019, respectively). The Kaplan–Meier curves of CSS in age cutoff of 55 years showed a significant association between no RAIT and RAIT (log-rank test, P = 0.0045). Univariate and multivariate Cox regression showed RAIT was associated with a reduced risk of mortality compared with no RAIT (hazard ratio [HR] 0.59, 95% confidence interval [95% CI 0.44–0.80]). Age (≥ 55) years showed a worse CSS regardless of whether or not a patient was treated or not treated with RAI ([HR] 8.91, 95% confidence interval [95% CI 6.19–12.84]).

Conclusions

RAIT improves OS and CSS in patients with intermediate-risk DTC after surgery. 55 years is a more appropriate prognostic age cutoff for the relevant classification systems and is a crucial consideration in RAI decision-making. Therefore, we need individualized treatment plans.

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Funding

Natural Science Foundation of China (No. 82070878). Natural Science Foundation of Fujian Province (Grant No. 2020J011081, 2021J01381 and 2022J01521).

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Authors and Affiliations

  1. Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China

    **wen Wang, Liantao Li, Jixing Liang, Huibin Huang, Wei Lin, Gang Chen & Jun** Wen

  2. Department of Internal Medicine, Fujian Provincial Hospital South Branch, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China

    Yaqian Mao

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Contributions

J.W.: Conceptualization (lead); writing – original draft (lead); data curation (lead); formal analysis (lead); software (equal). Y.M.: Writing – original draft (supporting); formal analysis (supporting); software (equal);. L.L.: Methodology (lead); writing – original draft (supporting); writing – review and editing (equal). J.L.: Writing – review and editing (equal). H.H.: Writing – review and editing (equal). Wei Lin:Methodology (supporting); writing – review and editing (equal). G.C.:Writing – review and editing (equal). J.W.:Conceptualization (supporting); supervision (lead) ;writing – original draft (supporting); writing – review and editing (equal).

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Correspondence to Wei Lin or Jun** Wen.

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These authors contributed equally: **wen Wang, Yaqian Mao, Liantao Li

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Wang, J., Mao, Y., Li, L. et al. Survival benefit of postoperative radioiodine therapy among patients with intermediate-risk differentiated thyroid carcinoma. Endocrine (2024). https://doi.org/10.1007/s12020-024-03869-2

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