Characteristics and prognosis of patients with thyroglobulin-positive and radioactive iodine whole-body scan-negative differentiated thyroid carcinoma.
OBJECTIVE
The prognosis of differentiated thyroid carcinoma is generally favorable. However, some patients have negative radioiodine whole-body scans and detectable serum thyroglobulin with biochemical radioiodine-refractory carcinoma and are candidates for treatment with a multikinase inhibitor, such as sorafenib. The purpose of this study is to investigate the characteristics and prognosis of differentiated thyroid carcinoma patients who are thyroglobulin positive and scan negative.


METHODS
We retrospectively classified 153 patients treated for 15 years by serum thyroglobulin level and radioiodine scan results and examined the relationship between clinical characteristics and prognosis.


RESULTS
Overall, 27% of the patients were classified as thyroglobulin positive/scan negative (positive/negative) while 61% were thyroglobulin negative/scan negative (double negative). Compared with double-negative patients, positive/negative patients were significantly older, predominantly male, had a higher pT and pN, stage, and had higher pre-operative thyroglobulin values. Positive/negative patients showed worse prognosis in terms of overall survival, disease-specific survival and disease-free survival than double-negative patients (10-year overall survival, 85 vs. 93%, P = 0.001; 10-year disease-specific survival, 94 vs. 100%, P = 0.03, 10-year disease-free survival, 77 vs. 93%, P < 0.001). Multivariate analysis revealed that positive/negative status was the only factor associated with disease-free survival, including age and TNM stage (hazard ratio: 6.37, 95% confidence interval: 1.22-33.3). However, the median duration of disease-free period for positive/negative patients was 14.2 years.


CONCLUSIONS
Few patients among thyroglobulin-positive/scan-negative patients are candidates for sorafenib, despite the significant survival differences from double-negative patients.
Department of Otolaryngology-Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe sinosino@kcho.jp.
Shogo
S
Shinohara
Department of Otolaryngology-Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe.
Masahiro
M
Kikuchi
Department of Otolaryngology-Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe.
Atsushi
A
Suehiro
Department of Otolaryngology-Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe.
Ippei
I
Kishimoto
Department of Otolaryngology-Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe.
Hiroyuki
H
Harada
Department of Radiology, Kobe City Medical Center General Hospital, Kobe.
Megumu
M
Hino
Department of Endocrinology, Kobe City Medical Center General Hospital, Kobe, Japan.
Takashi
T
Ishihara
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000097:blood / Q000378:metabolism*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007455:Iodine / Q000378:metabolism*; D007457:Iodine Radioisotopes / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000097:blood / Q000378:metabolism* / Q000601:surgery; D051598:Whole Body Imaging / Q000379:methods
D007457:Iodine Radioisotopes; D013954:Thyroglobulin; D007455:Iodine
radioiodine whole-body scan; sorafenib; survival analysis; thyroglobulin; thyroid differentiated carcinoma