Data-driven Thyroglobulin Cutoffs for Low- and Intermediate-risk Thyroid Cancer Follow-up: ITCO Real-world Analysis

被引:1
|
作者
Grani, Giorgio [1 ]
D'Elia, Silvia [2 ]
Puxeddu, Efisio [3 ]
Morelli, Silvia
Arvat, Emanuela [4 ]
Nervo, Alice [4 ]
Spiazzi, Giovanna [5 ]
Rolli, Nicoletta [5 ]
Zatelli, Maria Chiara [6 ]
Ambrosio, Maria Rosaria [6 ]
Ceresini, Graziano [7 ]
Marina, Michela [7 ]
Mele, Chiara [8 ]
Aimaretti, Gianluca [8 ]
Santaguida, Maria Giulia [9 ]
Virili, Camilla [9 ]
Crescenzi, Anna [10 ,11 ]
Palermo, Andrea [12 ]
Rossetto Giaccherino, Ruth [13 ]
Meomartino, Letizia [13 ]
Castagna, Maria Grazia [14 ]
Maino, Fabio [14 ]
Trevisan, Matteo [15 ]
De Leo, Simone [15 ]
Chiofalo, Maria Grazia [16 ]
Pezzullo, Luciano
Sparano, Clotilde [17 ]
Petrone, Luisa [17 ]
Di Dalmazi, Giulia [18 ]
Napolitano, Giorgio [18 ]
Tumino, Dario [19 ]
Crocetti, Umberto [20 ]
Bertagna, Francesco [21 ,22 ]
Deandrea, Maurilio [23 ]
Antonelli, Alessandro [24 ]
Mian, Caterina [25 ]
Carbone, Antonella [26 ]
Monti, Salvatore [27 ]
Porcelli, Tommaso [28 ]
Brigante, Giulia [29 ,30 ]
Barbaro, Daniele [31 ]
Alfo, Marco [2 ]
Ferraro Petrillo, Umberto [2 ]
Filetti, Sebastiano [1 ]
Durante, Cosimo [1 ]
机构
[1] Sapienza Univ Rome, Dept Translat & Precis Med, Viale Policlin 155, I-00161 Rome, Italy
[2] Sapienza Univ Rome, Dept Stat Sci, I-00185 Rome, Italy
[3] Univ Perugia, Dept Med & Surg, I-06129 Perugia, Italy
[4] Univ Turin, Citta Salute & Sci Hosp, Dept Med Sci, Oncol Endocrinol Unit, I-10126 Turin, Italy
[5] Azienda Osped Univ Verona, Dept Med, Endocrinol & Diabetol Unit, I-37126 Verona, Italy
[6] Univ Ferrara, Dept Med Sci, Sect Endocrinol Geriatr & Internal Med, I-44121 Ferrara, Italy
[7] Univ Hosp Parma, Unit Internal Med & Oncol Endocrinol, I-43126 Parma, Italy
[8] Univ Piemonte Orientale, Dept Translat Med, Endocrinol, I-28100 Novara, Italy
[9] Sapienza Univ Rome, Dept Med Surg Sci & Biotechnol, Endocrinol Unit, I-04100 Latina, Italy
[10] Sapienza Univ Rome, Dept Radiol Oncol & Pathol Sci, I-00161 Rome, Italy
[11] Fdn Policlin Univ Campus Biomed, Unit Endocrine Organs & Neuromuscolar Pathol, I-00128 Rome, Italy
[12] Fdn Policlin Univ Campus Biomed, Unit Metab Bone & Thyroid Dis, Rome, Italy
[13] Univ Turin, Dept Med Sci, Endocrinol Diabetol & Metab, I-10126 Turin, Italy
[14] Univ Siena, Dept Med Surg & Neurosci, Sect Endocrinol, I-53100 Siena, Italy
[15] IRCCS Ist Auxol Italiano, Dept Endocrine & Metab Dis, Endocrine Oncol Unit, I-20095 Milan, Italy
[16] NCI, IRCCS Fdn G Pascale, I-80131 Naples, Italy
[17] Univ Florence, Dept Expt & Clin Biomed Sci Mario Serio, Endocrinol Unit, I-50134 Florence, Italy
[18] Univ G Annunzio Chieti Pescara, Dept Med & Aging Sci, I-66100 Chieti, Italy
[19] Univ Catania, Dept Clin & Expt Med, I-95122 Catania, Italy
[20] IRCCS, Dept Med Sci, Hosp Casa Sollievo Sofferenza, I-71013 San Giovanni Rotondo, Italy
[21] Univ Brescia, Dept Med & Surg Specialties, Nucl Med, Radiol Sci, I-25123 Brescia, Italy
[22] Spedali Civili Brescia, I-25123 Brescia, Italy
[23] AO Ordine Mauriziano Torino, UO Endocrinol Diabetol & Malattie Metab, I-10128 Turin, Italy
[24] Univ Pisa, Dept Surg Med & Mol Pathol & Crit Area, I-56100 Pisa, Italy
[25] DIMED Univ Padua, Dept Med, Operat Unit Endocrinol, I-35128 Padua, Italy
[26] Tinchi Hosp, Endocrine Unit, Matera, Italy
[27] Sapienza Univ Rome, Endocrinol & Diabet Unit, Azienda Osped Univ Sant Andrea, I-00189 Rome, Italy
[28] Univ Naples Federico II, Dept Publ Hlth, I-80131 Naples, Italy
[29] Univ Modena & Reggio Emilia, Dept Biomed Metab & Neural Sci, Unit Endocrinol, I-41125 Modena, Italy
[30] Azienda Osped Univ Modena, Dept Med Specialties, Unit Endocrinol, I-41124 Modena, Italy
[31] Unit Endocrinol ASL North West Tuscany, Ospedali Riuniti, I-57124 Livorno, Italy
来源
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM | 2024年
关键词
thyroglobulin; threshold; predictor; treatment response; radioiodine; RADIOIODINE REMNANT ABLATION; SERUM THYROGLOBULIN; RADIOACTIVE IODINE; CLINICAL-PRACTICE; SELECTIVE USE; PAPILLARY; AUTOANTIBODY; GUIDELINES; MANAGEMENT; ASSAYS;
D O I
10.1210/clinem/dgae559
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context The utility of thyroglobulin (Tg) in the follow-up of patients with differentiated thyroid cancer has been well-documented. Although third-generation immunoassays have improved accuracy, limitations persist (interfering anti-Tg antibodies and measurement variability). Evolving treatment strategies require a reevaluation of Tg thresholds for optimal patient management.Objective To assess the performance of serum Tg testing in 2 populations: patients receiving total thyroidectomy and radioiodine remnant ablation (RRA) or treated with thyroidectomy alone.Design Prospective observational study.Setting Centers contributing to the Italian Thyroid Cancer Observatory database.Patients We included 540 patients with 5 years of follow-up and negative anti-Tg antibodies.Interventions Serum Tg levels assessed at 1-year follow-up visit.Main Outcome Measure Detection of structural disease within 5 years of follow-up.Results After excluding 26 patients with structural disease detected at any time point, the median Tg did not differ between patients treated with or without radioiodine. Data-driven Tg thresholds were established based on the 97th percentile of Tg levels in disease-free individuals: 1.97 ng/mL for patients undergoing thyroidectomy alone (lower than proposed by the Memorial Sloan Kettering Cancer Center protocol and ESMO Guidelines, yet demonstrating good predictive ability, with a negative predictive value of 98% and 0.84 ng/mL for patients receiving postsurgical RRA. High sensitivity and negative predictive value supported the potential of these thresholds in excluding structural disease.Conclusion This real-world study provides evidence for the continued reliability of 1-year serum Tg levels. The data-driven Tg thresholds proposed offer valuable insights for clinical decision-making in patients undergoing total thyroidectomy with or without RRA.
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