Classification Of Patients With Differentiated Thyroid Cancer With Different Risk Stratification And Analysis Of Factors Influencing The Efficacy After Surgery And ¹³¹I Therapy

Recent studies have found that after surgery and 131I treatment,patients with differentiated thyroid carcinoma(DTC)in the same risk stratification have a wide variation in response to treatment.Patients with an initial risk stratification of low risk may show an incomplete response after treatment,and conversely,patients with an initial risk stratification of intermediate to high risk who respond extremely well after initial treatment may even be reclassified as low risk patients.Understanding the clinicopathologic characteristics that affect the efficacy will help clinicians predict the efficacy of DTC patients with different clinicopathologic characteristics in the same risk stratification at the time of initial treatment,and even change the treatment strategy appropriately at the time of initial treatment to obtain a better efficacy.However,most studies at home and abroad have focused on validating the utility of the efficacy response restratification system and its predictive value for the risk of persistence or recurrence,with few reports on the factors influencing patients to achieve different efficacy.This study examines the possible different efficacy and factors influencing them after initial treatment in patients with low-、intermediate-、and high-risk DTC in the context of the 2015 American Thyroid Association(ATA)recurrence risk stratification and efficacy response restratification system to provide a basis for early assessment and personalized treatment and follow-up of DTC patients.Objective The efficacy classification of patients with low-risk,intermediate-risk,and high-risk differentiated thyroid cancer(DTC)after surgery and 131I treatment were studied separately,and the factors associated with different risk stratification that affect treatment efficacy were analyzed separately.Materials and Methods From January 2015 to January 2019,756 DTC patients(223 males,533 females;age.(44.3±11.7)years)in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Patients were divided into low-,intermediate-,and high-risk groups according to the 2015 American Thyroid Association(ATA)guidelines,and further divided into excellent response(ER),indeterminate response(IDR),biochemical incomplete response(BIR),and structural incomplete response(SIR)groups in the low-,intermediate-,and high-risk patient groups,respectively,based on the data measured in the stimulation status and the efficacy response reclassification system six months after surgery,and the BIR and SIR were further combined into the incomplete response(IR)group.χ2 test,Fisher exact test and Kruskal-Wallis rank sum test were used to compare the clinical characteristics among the four groups.The receiver operating characteristic(ROC)curve of the relationship with ER and IR was established.Multivariate logistic regression was used to analyze the independent influencing factors of ER and IR.Results 1.The proportions of patients in the ER,IDR,BIR,and SIR subgroups in the low-risk group were 75.21%(91/121),17.35%(21/121),7.44%(9/121),and 0,respectively;the proportions of patients in the ER,IDR,BIR,and SIR subgroups in the intermediate-risk group were 57.26%(217/379),33.24%(126/379),7.12%(27/379),and 2.38%(9/379);the proportion of patients in the ER,IDR,BIR,and SIR subgroups in the high-risk group was 48.05%(123/256),20,31%(52/256),19.53%(50/256),and 12.11%(31/256),respectively.2.The difference in psTg levels(H=22.875,P<0.001)between the efficacy groups in low-risk patients was statistically significant,and the cut-off values of psTg for predicting ER in low-risk patients was 8.68μg/L,with sensitivity and specificity of 72.2%and 74.6%,respectively.3.The differences in tumor size(H=18.866,P<0.001),N stage(χ2=17.389,P=0.009)and psTg level(H=-35.320,P<0.001)were statistically significant among the 4 groups of intermediate-risk patients.The cut-off values of psTg for predicting ER and IR were 4.06 μg/L and 8.10 μg/L with the sensitivity of 70.2%、84.6%,with the specificity of respectively.The cut-off values of tumor size for predicting ER and IR were 1.25 cm and 1.55 cm with the sensitivity of 58.6%and 70.8%,with the specificity 71.4%and 73.9%,respectively.Multivariate regression analysis showed that psTg<4.0μg/L(odds ratio(OR=7.438,95%CI:4.091-13.522),Nla stage(OR=2.658,95%CI:1.392-5.075)and tumor size<1.25 cm(OR=2.878,95%CI:1.594-5.198)were independent predictors of ER;psTg>8.1 μg/L(OR=7.426,95%CI:2.778-19.851),N1b stage(OR=2.442,95%CI:0.823-7.243)and tumor size>1.55 cm(OR=2.660,95%CI:1.033-6.849)were independent predictors of IR.4.The differences in gender(χ2=11.495,P=0.008),tumor size(H=21.368,P<0.001),N stage(χ2=42.012,P<0.001),distant metastasis(P<0.001)and psTg level(H=142.829,P<0.001)were statistically significant among the 4 groups of intermediate-risk patients.The cut-off values of psTg for predicting ER and IR were 5.38 μg/L and 15.85 μg/L with the sensitivity of 84.5%and 65.9%;with the specificity of 78.5%and 62.3%respectively.The cut-off values of tumor size for predicting ER and IR were 1.45 cm and 1.95 cm with the sensitivity of 89.0%and 91.4%、with the specificity of 52.6%and 74.0%respectively.Multivariate regression analysis showed that female(OR=2.305,95%CI:1.041-5.104),psTg<5.38 μg/L(OR=17.271,95%CI:8.561～34.841),N0 stage(OR=2.365,95%CI:1.104-5.066)and tumor size<1.5 cm(OR=2.194,95%CI:1.092～4.409)were independent predictors of ER;psTg>15.85 pg/L(OR=81.544,95%CI:30.561～217.577),N1b stage(OR=3.617,95%CI:1.276-10.253)and tumor size>4 cm(OR=47.060,95%CI:2.449-904.360)were independent predictors of IR.Conclusion The efficacy of DTC patients with different clinicopathological characteristics in the same risk stratum varied considerably after initial treatment.psTg>8.68μg/L was relatively poor in low-risk patients.psTg<5.38 μg/L.The mid-risk patients with psTg<4.0 μg/L,Nla stage and tumor size<1.25cm,high-risk patients with female,psTg<5.38 μg/L,NO stage and tumor size<1.5cm had better curative effect after initial treatment,while mid-risk patients with psTg>8.10μg/L,N1b stage,tumor diameter>1.55μg/L and high-risk patients with psTg>15.85μg/L,N1b stage and tumor diameter>4.0cm had poor curative effect after initial treatment.