Thyrotropin suppression and disease progression in patients with differentiated thyroid cancer: Results from the National Thyroid Cancer Treatment Cooperative Registry

被引:219
作者
Cooper, DS
Specker, B
Ho, M
Sperling, M
Ladenson, PW
Ross, DS
Ain, KB
Bigos, ST
Brierley, JD
Haugen, BR
Klein, I
Robbins, J
Sherman, SI
Taylor, T
Maxon, HR
机构
[1] Johns Hopkins Univ, Sch Med, Baltimore, MD USA
[2] S Dakota State Univ, Ethel Austin Program Nutr, Brookings, SD 57007 USA
[3] Univ Cincinnati, Med Ctr, Dept Pediat, Cincinnati, OH 45267 USA
[4] Univ Cincinnati, Med Ctr, Dept Radiol, Cincinnati, OH 45267 USA
[5] Johns Hopkins Univ, Sch Med, Div Endocrinol, Baltimore, MD USA
[6] Massachusetts Gen Hosp, Thyroid Unit, Boston, MA 02114 USA
[7] Univ Kentucky, Med Ctr, Div Endocrinol, Lexington, KY USA
[8] Maine Med Ctr, Div Endocrinol, Portland, ME 04102 USA
[9] Princess Margaret Hosp, Ontario Canc Inst, Toronto, ON M4X 1K9, Canada
[10] Univ Colorado, Hlth Sci Ctr, Div Endocrinol, Denver, CO USA
[11] N Shore Univ Hosp, Div Endocrinol, Manhasset, NY USA
[12] Cornell Univ, Coll Med, New York, NY 10021 USA
[13] NIH, Bethesda, MD 20892 USA
[14] Univ Texas, MD Anderson Cancer Ctr, Div Endocrinol, Houston, TX 77030 USA
[15] Bayer Corp, West Haven, CT USA
[16] Univ Cincinnati, Med Ctr, Cincinnati, OH 45267 USA
[17] Sinai Hosp, Div Endocrinol, Baltimore, MD 21215 USA
关键词
D O I
10.1089/thy.1998.8.737
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The ideal therapy for differentiated thyroid cancer is uncertain. Although thyroid hormone treatment is pivotal, the degree of thyrotropin (TSH) suppression that is required to prevent recurrences has not been studied in detail. We have examined the relation of TSH suppression to baseline disease characteristics and to the likelihood of disease progression in a cohort of thyroid cancer patients who have been followed in a multicenter thyroid cancer registry that was established in 1986. The present study describes 617 patients with papillary and 66 patients with follicular thyroid cancer followed annually for a median of 4.5 years (range 1-8.6 years). Cancer staging was assessed using a staging scheme developed and validated by the registry. Cancer status was defined as no residual disease; progressive disease at any follow-up time; or death from thyroid cancer. A mean TSH score was calculated for each patient by averaging all available TSH determinations, where 1 = undetectable TSH; 2 = subnormal TSH; 3 = normal TSH; and 4 = elevated TSH. Patients were also grouped by their TSH scores: group 1: mean TSH score 1.0-1.99; group 2: mean TSH score 2.0-2.99; group 3: mean TSH score 3.0-4.0. The degree of TSH suppression did not differ between papillary and follicular thyroid cancer patients. However, TSH suppression was greater in papillary cancer patients who were initially classified as being at higher risk for recurrence. This was not the case for follicular cancer patients, where TSH suppression was similar for ail patients. For all stages of papillary cancer, a Cox proportional hazards model showed that disease stage, patient age, and radioiodine therapy all predicted disease progression, but TSH score category did not. However, TSH score category was an independent predictor of disease progression in high risk patients (p = 0.03), but was no longer significant when radioiodine therapy was included in the model (p = 0.09). There were too few patients with follicular cancer for multivariate analysis. These data suggest that physicians use greater degrees of TSH suppression in higher risk papillary cancer patients. Our data do not support the concept that greater degrees of TSH suppression are required to prevent disease progression in low-risk patients, but this possibility remains in high-risk patients. Additional studies with more patients and longer follow-up may provide the answer to this important question.
引用
收藏
页码:737 / 744
页数:8
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