000			04163nam a22004217a 4500
008			190314s20192019 xxu||||| |||| 00| 0 eng d
022			_a2574-3805
024			_a10.1001/jamanetworkopen.2018.7754 [doi]
024			_a2723409 [pii]
040			_aOvid MEDLINE(R)
099			_a30707227
245			_aAssociation of Thyrotropin Suppression With Survival Outcomes in Patients With Intermediate- and High-Risk Differentiated Thyroid Cancer.
251			_aJAMA Network Open. 2(2):e187754, 2019 Feb 01.
252			_aJAMA netw. open. 2(2):e187754, 2019 Feb 01.
253			_aJAMA network open
260			_c2019
260			_fFY2019
265			_sepublish
266			_d2019-03-14
520			_aConclusions and Relevance: Patients with intermediate- and high-risk DTC might not benefit from thyrotropin suppression. This study provides the justification for a randomized trial.
520			_aDesign, Setting, and Participants: This cohort study used a multicenter database analysis including patients from tertiary referral centers and local clinics followed up for a mean (SD) of 7.2 (5.8) years. Patients with DTC treated uniformly with total thyroidectomy and radioactive iodine between January 1, 1979, and March 1, 2015, were included. Among the 1012 patients, 145 patients were excluded due to the lack of longitudinal thyrotropin measurements.
520			_aExposures: Levothyroxine therapy to target thyrotropin suppression with dose adjustments based on changing thyrotropin goal.
520			_aImportance: Suppression of thyrotropin (often referred to as thyroid-stimulating hormone, or TSH) with levothyroxine used in management of intermediate- and high-risk differentiated thyroid cancer (DTC) to reduce the likelihood of progression and death is based on conflicting evidence.
520			_aMain Outcomes and Measures: The primary outcome measures were overall survival and PFS. A Cox proportional hazards model was used to assess the contribution of age, sex, tumor size, histology, and lymph node and distant metastases at landmarks 1.5, 3.0, and 5.0 years. The patients were divided into 3 groups based on mean thyrotropin score before each landmark: (1) suppressed thyrotropin, (2) moderately suppressed or low-normal thyrotropin, and (3) low-normal or elevated thyrotropin.
520			_aObjective: To examine a cohort of patients with intermediate- and high-risk DTC to assess the association of thyrotropin suppression with progression-free survival (PFS) and overall survival.
520			_aResults: Among 867 patients (557 [64.2%] female; mean [SD] age, 48.5 [16.5] years) treated with a median (range) cumulative dose of 151 (30-1600) mCi radioactive iodine, disease progression was observed in 293 patients (33.8%), and 34 patients (3.9%) died; thus, the study was underpowered in death events. Thyrotropin suppression was not associated with improved PFS at landmarks 1.5 (P = .41), 3.0 (P = .51), and 5.0 (P = .64) years. At 1.5 and 3.0 years, older age (hazard ratio [HR], 1.06; 95% CI, 1.03-1.08 and HR, 1.05; 95% CI, 1.01-1.08, respectively), lateral neck lymph node metastases (HR, 4.64; 95% CI, 2.00-10.70 and HR, 4.02; 95% CI, 1.56-10.40, respectively), and distant metastases (HR, 7.54; 95% CI, 3.46-16.50 and HR, 7.10; 95% CI, 2.77-18.20, respectively) were independently associated with subsequent time to progression, while at 5.0 years, PFS was shorter for patients with lateral neck lymph node metastases (HR, 3.70; 95% CI, 1.16-11.90) and poorly differentiated histology (HR, 71.80; 95% CI, 9.80-526.00).
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
651			_aMedStar Washington Hospital Center
656			_aMedicine/Endocrinology
657			_aJournal Article
700			_aBikas, Athanasios
700			_aBurman, Kenneth D
700			_aWartofsky, Leonard
790			_aAuh S, Bikas A, Burman K, Chindris AM, Daley B, Dewey E, Gershengorn M, Kebebew E, Klubo-Gwiezdzinska J, Smallridge R, Urken M, Wartofsky L
856			_uhttps://dx.doi.org/10.1001/jamanetworkopen.2018.7754 _zhttps://dx.doi.org/10.1001/jamanetworkopen.2018.7754
942			_cART _dArticle
999			_c4162 _d4162