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Inflammatory biomarkers predict outcomes of patients with radioactive iodine refractory thyroid cancer treated with sorafenib

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Abstract

Background

The objective of this multicenter, retrospective cohort study was to evaluate the ability of inflammatory biomarkers representing the host immune system to predict outcomes in 70 patients with progressive radioactive iodine (RAI)-refractory thyroid cancer who were treated with sorafenib.

Method

Patients were divided into low and high inflammatory biomarker groups based on median values. Progression-free survival (PFS) and overall survival (OS) were assessed based on the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR).

Results

The median LMR, NLR, and PLR values were 3.4, 2.2, and 140.1, respectively. No significant differences were observed in baseline characteristics of high and low LMR, NLR and PLR groups. Median PFS values were 6.6 and 19.5 months in the low and high LMR groups, respectively (P < 0.001). Compared with the high NLR and PLR groups, PFS was significantly prolonged in the low NLR and PLR groups (P = 0.003 and P = 0.041 respectively). In the multivariate analysis, low LMR and high NLR were associated with poor PFS after adjusting for multiple confounding factors including age, sex, pathology, disease-related symptoms, serum thyroglobulin level, lung-only metastasis, cumulative RAI dose, time from diagnosis, and longer diameter of the target lesion (hazard ratio, HR = 2.42; 95% confidence interval, CI 1.25–4.71; P = 0.009, and HR = 2.09; CI, 1.06–4.14; P = 0.033, respectively). High LMR, low NLR, and low PLR were significantly associated with prolonged OS (P = 0.011, P = 0.023, and P = 0.007, respectively). Patients with at least one risk factors for inflammatory biomarkers presented a significantly lower PFS (HR 2.29; CI, 1.36–3.84; P = 0.003) and OS (HR 2.95; CI, 1.49–5.81; P = 0.006) than patients without any risk factor.

Conclusion

Baseline inflammatory biomarkers successfully predicted PFS and OS in patients with progressive RAI-refractory thyroid cancer treated with sorafenib. These prognostic biomarkers might help arrive at appropriate clinical decisions regarding the use of sorafenib.

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Acknowledgements

A part of this study was presented as poster at the 10th Seoul International Congress of Endocrinology and Metabolism, 2022.

Author contributions

Conception, design, review, and editing were performed by D.J.L. and W.G.K.; Data collection and curation were performed by M.J.J., E.Y.K., D.Y.S., B.H.K., W.B.K., and Y.K.S.; Analysis and the first draft of the manuscript was written by M.J. and M.K.; All authors read and approved the final manuscript.

Funding

This study was supported by clinical research grant from Pusan National University Hospital in 2022 and a grant (2022IP0011) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.

Author information

Author notes

  1. These authors contributed equally: Meihua Jin, Mijin Kim

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Meihua Jin, Min Ji Jeon, Won Bae Kim, Young Kee Shong & Won Gu Kim

  2. Division of Endocrinology and Metabolism, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea

    Meihua Jin

  3. Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea

    Mijin Kim & Bo Hyun Kim

  4. Department of Endocrinology, Dongnam Institute of Radiological and Medical Sciences Cancer Center, Busan, Republic of Korea

    Eui Young Kim

  5. Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Dong Yeob Shin

  6. Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Dong Jun Lim

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Conflict of interest

Author W.B.K., Y.K.S., and W.G.K. were advisory board members of Bayer, Eisai, Lilly, and Hanmi Pharmaceuticals. Otherwise, there are no competing financial interests that exist.

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The study protocol was approved by the Institutional Review Board of each participating institution. The study was conducted in accordance with the provisions of the Declaration of Helsinki.

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Jin, M., Kim, M., Jeon, M.J. et al. Inflammatory biomarkers predict outcomes of patients with radioactive iodine refractory thyroid cancer treated with sorafenib. Endocrine 81, 298–305 (2023). https://doi.org/10.1007/s12020-023-03348-0

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