Abstract

ABELLEIRA, E.; BUENO, F.  and  PITOIA, F.. Riesgo dinámico en cáncer diferenciado de tiroides: comparación entre pacientes ablacionados con aquellos no ablacionados de bajo riesgo y riesgo intermedio de recurrencia. Rev. argent. endocrinol. metab. [online]. 2019, vol.56, n.2, pp.21-31. ISSN 1851-3034.

The current approach of patients with differentiated thyroid carcinoma (DTC) is individualized according to the risk of recurrence (RR) of the disease. The static classification of the initial RR could be improved by applying the dynamic risk of recurrence to decide remnant ablation. The dynamic risk definition arise from the findings obtained during the initial follow-up.

The aim of this manuscript is to compare the response to treatment in patients with low and intermediate static RR in whom the decision for radioiodine remnant ablation (RRA) was performed immediately after surgery with those non-ablated patients with low dynamic RR. Secondary, to compare the responses to treatment in ablated patients with low static RR compared with those non-ablated low dynamic RR.

We included 412 patients, they were divided in two groups Group 1 (G1): n=309 ablated patients and Group 2 (G2): n=103 non-ablated patients. G1 also included 29 patients who received remnant ablation considering the dynamic risk (Tg levels > 5 ng/ml).

The initial structural incomplete response (SIR) was greater in G1 compared with G2 (11.3% vs 0.9%: p = <0.001). The frequency of an excellent response at the end of follow-up was similar in G2 compared with low initial RR of G1 (72.8% vs. 62.1%: p = 0.058).

In conclusion, low and intermediate static RR ablated patients had a higher frequency of SIR compared with non-ablated patients in the dynamic risk assessment. In contrast, the frequency of SIR was similar when ablated patients of low static RR were compared with those non-ablated patients of low dynamic risk. These results show how the dynamic RR helps to move those intermediate RR patients on the low RR decreasing the need for RRA.

Keywords : thyroid cáncer dynamic risk without remnant ablation structural incomplete response.

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