Importance One-third of patients with papillary thyroid cancer (PTC) develop persistent or recurrent disease after initial therapy. Most patients with persistent or recurrent disease undergo reoperation, but the role of treatment with radioactive iodine (RAI) after reoperation is unclear.

Objective To determine whether receipt of RAI after reoperation for recurrent PTC is associated with improved outcomes.

Design, Setting, and Participants This retrospective cohort study included electronic health record data from 102 patients who underwent neck reoperation for persistent or recurrent PTC at a tertiary referral center from April 2006 to January 2016; 50 patients received RAI after reoperation, and 52 did not receive RAI after reoperation. Data analysis was performed from September 1, 2017, to December 1, 2017.

Main Outcomes and Measures Suppressed thyroglobulin (Tg) levels were compared between patients who underwent reoperation and received RAI and patients who underwent reoperation without receipt of RAI at the following time points: before reoperation (Tg0), after reoperation (Tg1), and after RAI or a comparable time interval among patients whose cases were managed without RAI (Tg2). Outcomes were biochemical response and structural recurrence after reoperation.

Results The cohort comprised 102 patients who underwent neck reoperation for persistent or recurrent PTC (median age, 44 years [interquartile range, 33-54 years; SD, 14 years]; 67 [66%] female), 50 of whom received treatment with RAI after reoperation. Clinicopathologic characteristics of the patients at the time of the initial surgical procedure were similar between the reoperation with RAI group and the reoperation without RAI group with the exception of tumor (T) stage (T3 and T4, 28 of 50 [56%] vs 19 of 52 [37%]). Although median Tg levels were similar between the reoperation with RAI group and the reoperation without RAI group (Tg0, 3.3 ng/mL vs 2.4 ng/mL; Tg1, 0.6 ng/mL vs 0.2 ng/mL; and Tg2, 0.5 ng/mL vs 0.2 ng/mL; all differences were nonsignificant), the rate of excellent response at Tg1 was lower in the reoperation with RAI group (4 of 33 [12%] vs 24 of 51 [47%]; P = .007). Structural recurrence after reoperation occurred in 18 of 50 patients (36%) in the reoperation with RAI group and 10 of 52 patients (19%) in the reoperation without RAI group. In multivariable analysis accounting for clinicopathologic characteristics and Tg0, receipt of RAI after reoperation was not associated with the rate of a second structural recurrence. In subset analyses limited to patients with incomplete response to reoperation and patients with T3 or T4 tumors, no association between receipt of RAI and the risk of a second recurrence was found.

Conclusions and Relevance Patients who received RAI after reoperation had outcomes similar to those in patients who underwent reoperation alone. RAI after reoperation was not associated with a significant clinical benefit in this limited series. Larger multicenter studies are required to determine whether receipt of RAI after reoperation improves outcomes among patients with recurrent PTC.

重要性 三分之一的甲状腺乳头状癌 (PTC) 患者在初始治疗后会出现持续或复发的疾病。大多数持续或复发性疾病的患者接受再次手术，但再次手术后放射性碘（RAI）治疗的作用尚不清楚。

目的 确定复发性 PTC 再次手术后接受 RAI 是否与改善结果相关。

设计、设置和参与者 这项回顾性队列研究包括 2006 年 4 月至 2016 年 1 月在三级转诊中心因持续性或复发性 PTC 接受颈部再手术的 102 名患者的电子健康记录数据；50例患者再次手术后接受RAI，52例患者再次手术后未接受RAI。数据分析时间为2017年9月1日至2017年12月1日。

主要结果和措施 在以下时间点比较接受再手术并接受 RAI 的患者与接受再手术但未接受 RAI 的患者之间的甲状腺球蛋白 (Tg) 抑制水平：再手术前 (Tg0)、再手术后 (Tg1) 和 RAI 后或在没有 RAI 的情况下处理病例的患者之间具有可比的时间间隔（Tg2）。结果是再次手术后的生化反应和结构复发。

结果 该队列包括 102 名因持续性或复发性 PTC 接受颈部再手术的患者（中位年龄，44 岁 [四分位距，33-54 岁；SD，14 岁]；67 [66%] 名女性），其中 50 名接受 RAI 治疗再次手术后。除了肿瘤 (T) 分期（T3 和 T4，28 of 50 [56%] vs 19 52 [37%]）。尽管 RAI 再手术组和无 RAI 再手术组的中位 Tg 水平相似（Tg0，3.3 ng/mL vs 2.4 ng/mL；Tg1，0.6 ng/mL vs 0.2 ng/mL；和 Tg2，0.5 ng/mL与 0.2 ng/mL 相比；所有差异均不显着），P  = .007）。RAI 再手术组 50 例患者中有 18 例（36%）发生再手术后结构复发，而无 RAI 再手术组 52 例患者中有 10 例（19%）。在考虑临床病理特征和 Tg0 的多变量分析中，再次手术后接受 RAI 与第二次结构性复发率无关。在仅限于对再次手术反应不完全的患者和 T3 或 T4 肿瘤患者的亚组分析中，未发现接受 RAI 与二次复发风险之间存在关联。

结论和相关性 再 手术后接受 RAI 的患者的结果与单独接受再手术的患者相似。在这个有限的系列中，再手术后的 RAI 与显着的临床益处无关。需要更大规模的多中心研究来确定再次手术后接受 RAI 是否能改善复发性 PTC 患者的预后。