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Regional nodal metastases carry prognostic significance in papillary thyroid cancer (PTC). However, whether different locational nodal metastases correlate with different therapeutic responses remains controversial. We innovatively applied the response to therapy re-stratification system (RTRS) to evaluate the dynamic disease status after surgery and radioiodine (RAI) therapy in PTC patients with different locational nodal metastases. A total of 585 non-distant-metastatic PTC patients who underwent total thyroidectomy and RAI therapy were retrospectively enrolled. Patients with nodal metastases were categorized into N1a and N1b groups. Propensity score matching (PSM) was used to balance the bias between two groups. Therapeutic responses were dynamically evaluated, and responses to RAI therapy were classified into excellent(ER), indeterminate(IDR), biochemical incomplete(BIR) and structural incomplete response(SIR). N1b group patients showed a significantly higher pre-ablation stimulated thyroglobulin (Ps-Tg) level than N1a group patients (7.4ng/mL vs 3.2ng/mL, <0.001). After RAI therapy, N1b group patients took longer time to achieve ER (9.86 months vs 3.29 months, <0.001) and exhibited a higher proportion of non-ER (IDR, BIR and SIR) (39.15% vs 17.46%, <0.001) compared to N1a group patients. In logistic regression, N1b and Ps-Tg≥10ng/mL were confirmed to be independent factors predicting non-ER (Odds Ratio, 2.591, 9.196, respectively). In Cox regression, patients with N1b disease and Ps-Tg≥10ng/mL showed significantly lower hazards for achieving ER (Hazard Ratio, 0.564, 0.223, respectively). N1b PTC patients showed inferior responses to surgery and RAI therapy compared to N1a patients. N1b was confirmed to be an independent factor predicting unfavorable responses to RAI therapy.
This article was published in the following journal.
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A thyroid neoplasm of mixed papillary and follicular arrangement. Its biological behavior and prognosis is the same as that of a papillary adenocarcinoma of the thyroid. (From DeVita Jr et al., Cancer: Principles & Practice of Oncology, 3d ed, p1271)
An aggressive THYROID GLAND malignancy which generally occurs in IODINE-deficient areas in people with previous thyroid pathology such as GOITER. It is associated with CELL DEDIFFERENTIATION of THYROID CARCINOMA (e.g., FOLLICULAR THYROID CARCINOMA; PAPILLARY THYROID CANCER). Typical initial presentation is a rapidly growing neck mass which upon metastasis is associated with DYSPHAGIA; NECK PAIN; bone pain; DYSPNEA; and NEUROLOGIC DEFICITS.
Preliminary cancer therapy (chemotherapy, radiation therapy, hormone/endocrine therapy, immunotherapy, hyperthermia, etc.) that precedes a necessary second modality of treatment.
Tumors or cancer of the THYROID GLAND.
Inflammatory disease of the THYROID GLAND due to autoimmune responses leading to lymphocytic infiltration of the gland. It is characterized by the presence of circulating thyroid antigen-specific T-CELLS and thyroid AUTOANTIBODIES. The clinical signs can range from HYPOTHYROIDISM to THYROTOXICOSIS depending on the type of autoimmune thyroiditis.
The thyroid is a butterfly-shaped gland in the neck, just above thecollarbone and is an endocrine gland that make hormones. These Thyroid hormones control the rate of many activities in the body, including how fast the body burns calories and how fast th...
Surgery is a technology consisting of a physical intervention on tissues. All forms of surgery are considered invasive procedures; so-called "noninvasive surgery" usually refers to an excision that does not penetrate the structure being exci...