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. 2024 Jan 17:14:1307325.
doi: 10.3389/fendo.2023.1307325. eCollection 2023.

Higher adjuvant radioactive iodine therapy dosage helps intermediate-risk papillary thyroid carcinoma patients achieve better therapeutic effect

Xue Li #  1 , Hongyuan Zheng #  1 , Chao Ma  2 , Yanhui Ji  1 , Xuan Wang  1 , Danyang Sun  3 , Zhaowei Meng  1 , Wei Zheng  1
Affiliations

Higher adjuvant radioactive iodine therapy dosage helps intermediate-risk papillary thyroid carcinoma patients achieve better therapeutic effect

Xue Li et al. Front Endocrinol (Lausanne). .

Abstract

Objective: This retrospective study aims to evaluate the therapeutic effect of varying dosages of adjuvant radioactive iodine (RAI) therapy on intermediate-risk papillary thyroid carcinoma (PTC) patients.

Methods: This retrospective study involved a total of 427 intermediate-risk PTC patients, out of which 202 received a 3.7GBq dosage of RAI, and 225 received a 5.55GBq dosage. The evaluation involved assessing the therapeutic outcomes, number of treatment cycles, and successful remnant ablation rates in both dose groups, six months post-adjuvant RAI therapy. Univariate and multivariate logistic regression analyses were employed to identify factors linked with excellent response (ER). Following this, prognostic nomograms were constructed to provide a visual representation of the prediction models. Calibration curves, the concordance index (C-index), and the receiver operating characteristic (ROC) curve were employed to evaluate the predictive performance of these nomograms. The Hosmer-Lemeshow test was applied to assess the models' goodness-of-fit. Additionally, the clinical utility of the prognostic nomograms was appraised through decision curve analysis (DCA).

Results: The high-dose (HD) group exhibited significantly higher proportions of ER, single treatment cycles, and successful remnant ablation rates (p<0.05). Being male, receiving a 3.7GBq dose, having an N1b stage, an sTg level ≥10ng/ml, or an sTg/TSH ratio ≥0.11 were independent risk factors for Non-ER. Two prognostic nomograms, "sTg Nomogram" and "sTg/TSH Nomogram", were established. The ranking of factors contributing to ER, in descending order, included the sTg or sTg/TSH ratio, N stage, therapy dosage, sex, and soft tissue invasion. The "sTg/TSH Nomogram" demonstrated a higher C-index compared to the "sTg Nomogram". The calibration curves indicated excellent calibration for both nomograms. DCA demonstrated that the net benefit of the "sTg/TSH Nomogram" was higher than that of the "sTg Nomogram".

Conclusion: Higher initial RAI therapy doses can improve therapeutic efficacy for intermediate-risk PTC patients. The developed nomograms, particularly the "sTg/TSH Nomogram", could assist clinicians in optimal therapeutic decision-making.

Keywords: adjuvant radioactive iodine therapy; decision curve analysis (DCA); dosages; intermediate-risk papillary thyroid carcinoma; therapy response.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
“sTg nomogram” predicting ER rates for intermediate-risk PTC patients receiving RAI.
Figure 2
Figure 2
“sTg/TSH nomogram” predicting ER probability for intermediate-risk PTC patients receiving RAI.
Figure 3
Figure 3
Individual “sTg/TSH nomogram” predicting ER probability for a female intermediate-risk PTC patient with N1a, no soft tissue invasion, sTg/TSH<0.11 receiving 5.55GBq RAI therapy.
Figure 4
Figure 4
(A) Calibration curve for the “sTg nomogram” and “sTg/TSH nomogram”. (B) ROC curve for the “sTg nomogram” and “sTg/TSH nomogram”.
Figure 5
Figure 5
Decision curves of the “sTg nomogram” and “sTg/TSH nomogram”.
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The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.