저위험 갑상선 분화암 환자에서 수술 후 radioiodine 치료의 이득 부족

저위험 갑상선 분화암 환자에서 수술 후 radioiodine 치료의 이득 부족

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Radioiodine의 유무에 따른 결과가 동등하다는 높은 질의 증거가 부족하지만, 일반적으로 저위험 갑상선 분화암 환자에서 수술 후 radioiodine은 투여되지 않습니다. 저위험 갑상선 분화암 (T1a or T1b, both with N0 or Nx, and without aggressive pathologic subtypes or extrathyroidal extension) 환자 730명을 대상으로 수술 후 radioiodine을 투여하지 않는 것과 radioiodine을 투여한 것을 평가한 무작위 시험에서, 3년 째 질병 관련 결과는 두 그룹에서 유사하였습니다. 이 연구 셜과는 저위험 갑상선 분화암 환자에서 lobectomy 또는 total thyroidectmoy를 시행한 이후 일상적으로 radioiodine을 투여하지 않는 현행 관행을 뒷받침합니다.

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Differentiated and anaplastic thyroid carcinoma TNM staging AJCC UICC 8th edition

Primary tumor (T)
Papillary, follicular, poorly differentiated, Hürthle cell and anaplastic thyroid carcinoma
T category	T criteria
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
T1	Tumor ≤2 cm in greatest dimension limited to the thyroid
T1a	Tumor ≤1 cm in greatest dimension limited to the thyroid
T1b	Tumor >1 cm but ≤2 cm in greatest dimension limited to the thyroid
T2	Tumor >2 cm but ≤4 cm in greatest dimension limited to the thyroid
T3	Tumor >4 cm limited to the thyroid, or gross extrathyroidal extension invading only strap muscles
T3a	Tumor >4 cm limited to the thyroid
T3b	Gross extrathyroidal extension invading only strap muscles (sternohyoid, sternothyroid, thyrohyoid, or omohyoid muscles) from a tumor of any size
T4	Includes gross extrathyroidal extension beyond the strap muscles
T4a	Gross extrathyroidal extension invading subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve from a tumor of any size
T4b	Gross extrathyroidal extension invading prevertebral fascia or encasing the carotid artery or mediastinal vessels from a tumor of any size
NOTE: All categories may be subdivided: (s) solitary tumor and (m) multifocal tumor (the largest tumor determines the classification).
Regional lymph nodes (N)
N category	N criteria
NX	Regional lymph nodes cannot be assessed
N0	No evidence of locoregional lymph node metastasis
N0a	One or more cytologically or histologically confirmed benign lymph nodes
N0b	No radiologic or clinical evidence of locoregional lymph node metastasis
N1	Metastasis to regional nodes
N1a	Metastasis to level VI or VII (pretracheal, paratracheal, or prelaryngeal/Delphian, or upper mediastinal) lymph nodes. This can be unilateral or bilateral disease.
N1b	Metastasis to unilateral, bilateral, or contralateral lateral neck lymph nodes (levels I, II, III, IV, or V) or retropharyngeal lymph nodes
Distant metastasis (M)
M category	M criteria
M0	No distant metastasis
M1	Distant metastasis
Prognostic stage groups
Differentiated
When age at diagnosis is...	And T is...	And N is...	And M is...	Then the stage group is...
<55 years	Any T	Any N	M0	I
<55 years	Any T	Any N	M1	II
≥55 years	T1	N0/NX	M0	I
≥55 years	T1	N1	M0	II
≥55 years	T2	N0/NX	M0	I
≥55 years	T2	N1	M0	II
≥55 years	T3a/T3b	Any N	M0	II
≥55 years	T4a	Any N	M0	III
≥55 years	T4b	Any N	M0	IVA
≥55 years	Any T	Any N	M1	IVB
Anaplastic
When T is...	And N is...	And M is...	Then the stage group is...
T1-T3a	N0/NX	M0	IVA
T1-T3a	N1	M0	IVB
T3b	Any N	M0	IVB
T4	Any N	M0	IVB
Any T	Any N	M1	IVC

TNM: tumor, node, metastasis; AJCC: American Joint Committee on Cancer; UICC: Union for International Cancer Control.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing. Corrected at 4th printing, 2018.

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REF. UpToDate 2022.05.01

N Engl J Med 2022; 386:923-932