Clinical Scorecard: Factors Affecting and Predictive Modeling of Postoperative Efficacy of Adjuvant ¹³¹I Treatment in Differentiated Thyroid Cancer Patients

At a Glance

Key Highlights

• 48.40% of patients did not achieve excellent response after 100 mCi adjuvant ¹³¹I therapy.
• Independent risk factors for non-excellent response include BMI, number of metastatic lymph nodes, stimulated thyroglobulin, and BRAF mutation.
• The random forest model showed the best predictive performance with an AUC of 90.77%.
• Concurrent high stimulated thyroglobulin, multiple lymph node metastases, and elevated BMI indicate a 100% risk of non-excellent response.

Guideline-Based Recommendations

Diagnosis

• Pathologically confirm differentiated thyroid cancer after total thyroidectomy.

Management

• Administer adjuvant ¹³¹I therapy at a fixed activity of 100 mCi for high-risk patients.

Monitoring & Follow-up

• Evaluate response at 6 months post-therapy using stimulated thyroglobulin and imaging findings.

Risks

• Consider BMI, lymph node metastases, and stimulated thyroglobulin levels as independent risk factors for treatment response.

Patient & Prescribing Data

376 patients with differentiated thyroid cancer, aged 13-74 years.

Patients with high stimulated thyroglobulin levels (≥ 3.3 ng/ml), multiple lymph node metastases (≥ 9.5 nodes), and elevated BMI (≥ 29.345 kg/m²) are at extreme risk for non-excellent response.

Clinical Best Practices

• Use multivariate analysis to identify independent risk factors for treatment response.
• Employ predictive modeling techniques such as random forest for better treatment outcome predictions.
• Ensure consistent detection methods and examination protocols across all patients.

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