Prete et al., Endocrine (2024)—A High-Quality Retrospective Cohort Study with Advanced Adjustment Methods, Assessing the Benefit of RAI in Intermediate-Risk DTC Patients with Multiple Risk Factors

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Study Design and Methods:
    • Type:
      • Retrospective cohort of 469 consecutive ATA low / intermediate-risk DTC patients:
        • From 2009 to 2015
    • Groups:
      • RAI-treated:
        • 328 (69.9%)
      • No-RAI:
        • 141 (30.1%)
    • Primary Outcome:
      • Composite biochemical or structural recurrence at median 17.5 months
    • Adjustment Method:
      • Inverse-Probability Weighted Regression Adjustment (IPWRA):
        • To control for selection bias and baseline confounders
  • Key Results:
    • Overall recurrence rates:
      • RAI group:
        • 9.6% (95% CI 6.3–12.9%)
      • No-RAI group:
        • 15.9% (95% CI 11.1–20.7%)
    • Relative Risk Reduction:
      • 42% lower recurrence with RAI:
        • RR = 0.58; 95% CI 0.35–0.91; p = 0.018
    • Recurrence risk factors (multivariable analysis):
      • pN1 disease:
        • OR 4.07
      • Male sex:
        • OR 2.71
      • Larger tumor size:
        • OR 1.03 per mm
      • Microscopic ETE:
        • OR 2.36
    • Subgroup benefit:
      • Greatest in patients with ≥ 2 intermediate-risk factors:
        • pN1
        • mETE
  • Clinical Implications for Surgeons:
    • In intermediate-risk patients with multiple adverse features:
      • RAI appears to significantly reduce recurrence
    • Risk features amplifying benefit include:
      • Clinical / pathologic lymph node metastasis (pN1)
      • Microscopic ETE
      • Larger primary tumors
      • Male gender
    • Absolute recurrence reduction:
      • ~ 6.3% in this cohort:
        • Notable for patient counseling
  • Surgical Considerations:
    • Multifactor intermediate-risk disease:
      • Should prompt strong consideration for adjuvant RAI
    • Younger patients, low-risk burden (e.g., single small node, no ETE):
      • May still be appropriate for surveillance
    • Shared decision-making critical:
      • Discuss ~ 6% absolute benefit balanced against RAI side effects
    • RAI dose and prep:
      • Not specified in the study; current practice supports 60 to 100 mCi with rhTSH preparation
  • In summary:
    • Prete et al. provide robust level III evidence that RAI reduces recurrence in intermediate-risk DTC patients with multiple adverse factors
    • This supports a nuanced, risk-adapted recommendation for RAI use in your multidisciplinary practice
  • Reference:
    • Prete A, et al. Benefit of RAI in intermediate-risk DTC patients with multiple features. Endocrine. 2024;84(1):123–131.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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