Radioactive iodine in differentiated thyroid cancer: A national database perspective

Ryan K. Orosco, Timon Hussain, Julia E. Noel, David C. Chang, Chrysoula Dosiou, Erik Mittra, Vasu Divi, Lisa A. Orloff

Research output: Contribution to journalArticle

Abstract

Radioactive iodine (RAI) is a key component in the treatment of differentiated thyroid cancer. RAI has been recommended more selectively in recent years as guidelines evolve to reflect risks and utility in certain patient subsets. In this study we sought to evaluate the survival impact of radioactive iodine in specific thyroid cancer subgroups. Nationwide retrospective cohort study of patients using the National Cancer Database (NCDB) from 2004 to 2012 and Surveillance, Epidemiology, and End Results (SEER) database from 1992 to 2009 examining patients with differentiated thyroid cancer treated with or without RAI. Primary outcomes included all-cause mortality (NCDB and SEER), and cancer-specific mortality (SEER). Cox multivariate survival analyses were applied to each dataset, and in 135 patient subgroups based on clinical and non-clinical parameters. A total of 199,371 NCDB and 77,187 SEER patients were identified. RAI was associated with improved all-cause mortality (NCDB: RAI hazard ratio (HR) 0.55, P < 0.001; SEER: HR 0.64, P < 0.001); and cancer-specific mortality (SEER: HR 0.82, P = 0.029). Iodine therapy showed varied efficacy within each subgroup. Patients with high-risk disease experienced the greatest benefit in all-cause mortality, followed by intermediate-risk, then low-risk subgroups. Regarding cancer-specific mortality, radioactive iodine therapy was protective in high-risk patients, but did not achieve statistical significance in most intermediate-risk subgroups. Low-risk T1a subgroups demonstrated an increased likelihood of cancer-specific mortality with iodine therapy. The efficacy of RAI in patients with differentiated thyroid cancer varies by disease severity. A negative cancer-specific survival association was identified in patients with T1a disease. These findings warrant further evaluation with prospective studies.

Original languageEnglish (US)
Pages (from-to)795-802
Number of pages8
JournalEndocrine-Related Cancer
Volume26
Issue number10
DOIs
StatePublished - Jan 1 2019

Fingerprint

Thyroid Neoplasms
Iodine
Databases
Epidemiology
Mortality
Neoplasms
Survival
Therapeutics
Survival Analysis
Cohort Studies
Multivariate Analysis
Retrospective Studies
Prospective Studies
Guidelines

Keywords

  • Radioactive iodine
  • Risk stratification
  • Surgical outcomes
  • Thyroid cancer

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Oncology
  • Endocrinology
  • Cancer Research

Cite this

Orosco, R. K., Hussain, T., Noel, J. E., Chang, D. C., Dosiou, C., Mittra, E., ... Orloff, L. A. (2019). Radioactive iodine in differentiated thyroid cancer: A national database perspective. Endocrine-Related Cancer, 26(10), 795-802. https://doi.org/10.1530/ERC-19-0292

Radioactive iodine in differentiated thyroid cancer : A national database perspective. / Orosco, Ryan K.; Hussain, Timon; Noel, Julia E.; Chang, David C.; Dosiou, Chrysoula; Mittra, Erik; Divi, Vasu; Orloff, Lisa A.

In: Endocrine-Related Cancer, Vol. 26, No. 10, 01.01.2019, p. 795-802.

Research output: Contribution to journalArticle

Orosco, RK, Hussain, T, Noel, JE, Chang, DC, Dosiou, C, Mittra, E, Divi, V & Orloff, LA 2019, 'Radioactive iodine in differentiated thyroid cancer: A national database perspective', Endocrine-Related Cancer, vol. 26, no. 10, pp. 795-802. https://doi.org/10.1530/ERC-19-0292
Orosco, Ryan K. ; Hussain, Timon ; Noel, Julia E. ; Chang, David C. ; Dosiou, Chrysoula ; Mittra, Erik ; Divi, Vasu ; Orloff, Lisa A. / Radioactive iodine in differentiated thyroid cancer : A national database perspective. In: Endocrine-Related Cancer. 2019 ; Vol. 26, No. 10. pp. 795-802.
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