Association of Free Thyroxine with Progression-Free Survival in Intermediate and High Risk Differentiated Thyroid Cancer

甲状腺癌 游离甲状腺素 肿瘤科 内科学 癌症 医学 联想(心理学) 甲状腺 内分泌学 心理学 甲状腺功能 心理治疗师
作者
Raisa Ghosh,Sungyoung Auh,Sriram Gubbi,Padmasree Veeraraghavan,Craig Cochran,Leila Shobab,Mark L. Urken,Kenneth D. Burman,Leonard Wartofsky,Joanna Kłubo-Gwieździńska
出处
期刊:The Journal of Clinical Endocrinology and Metabolism [The Endocrine Society]
标识
DOI:10.1210/clinem/dgae537
摘要

Abstract Context Supraphysiologic T4 doses are used in intermediate- and high-risk patients with differentiated thyroid cancer (IR/HR-DTC) to suppress tumor progression by TSH. However, preclinical data suggest that T4 can also act as a growth stimulus for cancer, but there is no clinical evidence supporting this claim. Objective We analyzed the association between free T4 (FT4) and progression-free survival (PFS) in patients with IR/HR-DTC. Methods This longitudinal cohort study, approved by multi-institutional review board, included patients with IR/HR-DTC treated uniformly with total thyroidectomy, radioiodine, and TSH suppression therapy, with at least 3 TSH and FT4 values available. Association between FT4 and PFS at landmarks 6, 12, and 18 months was assessed by Kaplan-Meier survival curves, whereas competing risks were assessed through Cox proportional hazards model. Results From 739 screened patients, 382 met the inclusion criteria and were characterized by a median age of 46 (34-59) years, 64.1% women, and treated with a median radioiodine dosage of 159 (110-410) mCi. During follow up of 7.1 (3.4-12.7) years, 34.6% experienced disease progression. Elevated FT4, observed in 29.3% of patients, was not associated with worse PFS (hazard ratio [HR], 0.9; CI, 0.54-1.5; P = .69), whereas age (HR, 1.02; CI, 1.004-1.04; P = .01), tumor size (HR, 1.15; CI, 1.04-1.28; P = .01) and metastases to the lateral neck lymph nodes (HR, 2.9; CI, 1.7-4.74; P < .001), bones (HR, 4.87; CI, 1.79-13.3; P = .002), and brain (HR, 5.56; CI; 2.54-12.2; P < .001) were associated with shorter PFS. Conclusion Contrary to preclinical evidence, elevated FT4 levels do not affect PFS in patients with IR/HR-DTC.

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