A novel nomogram integrated with preablation stimulated thyroglobulin and thyroglobulin/thyroid-stimulating hormone ratio to predict the therapeutic response of intermediate­ and high­risk differentiated thyroid cancer patients: a bi-center retrospective study.

PURPOSE: To investigate the factors influencing the outcome of radioactive iodine (RAI) treatment in intermediate- to high-risk patients with differentiated thyroid carcinoma (DTC). METHODS: We enrolled 553 DTC patients who underwent total thyroidectomy and categorized them into two groups according to their response to RAI therapy: excellent response (ER) and non-ER groups. Clinical and pathological characteristics of the patients were collected and retrospectively analyzed using univariate and multivariate binary logistic regression. Receiver operating characteristic (ROC) curves and diagnostic cutoff values were analyzed to assess the predictive value of important quantitative influences on 131I treatment outcomes. A new nomogram model was developed based on the above independent risk factors. R software was used to develop nomograms with all the independent prognostic factors included. RESULTS: The multivariate analysis showed that lymph node metastasis (LNM), stimulated thyroglobulin (sTg), thyroglobulin antibodies (TgAb), and sTg/thyroid-stimulating hormone (TSH) were significantly associated with non-ER of DTC patients. In the training set, the consistency index (C-index) of the new column line graph was 0.868 (95% CI 0.865-0.871). CONCLUSION: We proposed a new nomogram to predict non-ER for DTC with excellent discrimination and calibration.

Predicting skip metastasis in lateral lymph nodes of papillary thyroid carcinoma based on clinical and ultrasound features.

Background: Skip metastasis in papillary thyroid cancer (PTC), defined as lateral lymph node metastasis (LLNM) without the involvement of central lymph node metastasis (CLNM), is generally unpredictable. Our study aimed to develop a model to predict skip metastasis by using clinicopathological and ultrasound factors of PTC. Methods: We retrospectively reviewed the medical records of patients who underwent total thyroidectomy and central lymph node dissection (CLND) plus lateral lymph node dissection (LLND) between January 2019 and December 2021 at the First Affiliated Hospital of Soochow University. Furthermore, univariate and multivariate analyses assessed the clinical and ultrasound risk factors. Receiver operating characteristic (ROC) curves were used to find the optimal cut-off values for age and dominant nodule diameter. Multivariate logistic regression analysis results were used to construct a nomogram and were validated internally. Results: In all patients, the skip metastasis rate was 15.4% (41/267). Skip metastasis was more frequently found in patients with a tumour size ≤10 mm (OR 0.439; P = 0.033), upper tumour location (OR 3.050; P=0.006) and fewer CLNDs (OR 0.870; P = 0.005). After analysing the clinical and ultrasound characteristics of the tumour, five factors were ultimately associated with lateral lymph node skip metastasis and were used to construct the model. These factors were an age >40 years, tumour diameter <9.1 mm, upper tumour location, non-smooth margin and extrathyroidal extension. The internally evaluated calibration curves indicated an excellent correlation between the projected and actual skip metastasis probability. The nomogram performed well in discrimination, with a concordance index of 0.797 (95% CI, 0.726 to 0.867). Conclusions: This study screened for predictors of skip metastasis in PTC and established a nomogram that effectively predicted the risk of potential skip metastasis in patients preoperatively. The method can predict and distinguish skip metastases in PTC in a simple and inexpensive manner, and it may have future therapeutic utility.

Radioactive Iodine Ablation Can Reduce the Structural Recurrence Rate of Intermediate-Risk Papillary Thyroid Microcarcinoma: A Meta-Analysis.

Background: The incidence of papillary thyroid microcarcinoma (PTMC) has significantly increased in recent years, and the decision to use radioactive iodine (RAI) ablation in low-risk (LR) and intermediate-risk (IR) patients is controversial. The aim of this study was to evaluate whether RAI ablation can reduce the recurrence rate in LR-IR PTMC patients. Methods: A comprehensive literature search of the PubMed, Embase, Cochrane Library, and Web of Science was conducted according to the PRISMA statement. Results: There were 8 studies in English that fit our search strategy, and a total of 2847 patients were evaluated. The results of the meta-analysis showed RAI ablation in LR-IR PTMC patients did not reduce cancer recurrence (risk radio (RR) 0.56, 95% CI 0.19-1.70, P = 0.31). Nevertheless, we further performed data analysis and found that IR PTMC patients without RAI ablation had a higher rate of cancer recurrence than those who underwent RAI ablation (RR 0.23, 95% CI 0.11-0.49, P = 0.0001). Furthermore, patients with risk factors for lymph node metastasis (RR 0.16, 95% CI 0.06-0.42, P = 0.0002), microscopic extrathyroidal extension (RR 0.19, 95% CI 0.06-0.60, P = 0.005), and multifocality (RR 0.13, 95% CI 0.04-0.45, P = 0.001) in the absence of RAI ablation were more likely to have recurrence. Conclusions: Based on our current evidence, RAI ablation can reduce the cancer recurrence rate over 5 years in IR PTMC patients, especially when patients have some risk factors, such as lymph node metastasis, microscopic extrathyroidal extension, and multifocality.