Abstract
This study aimed to evaluate the therapeutic efficacy of radioactive iodine (RAI) in a large population-based cohort of male patients with differentiated thyroid cancer (DTC). Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, we conducted a nationwide retrospective cohort study encompassing male patients with DTC from 2000 to 2020. The study compared outcomes between patients treated with RAI and those who did not receive RAI. Propensity score-matching was employed to ensure comparability between the groups. Survival analyses were performed using the Kaplan-Meier method, and differences in survival were assessed using the log-rank test. Additionally, a multivariate Cox regression model was used to identify significant predictors of survival. A cohort comprising 48,164 male patients with differentiated thyroid carcinoma (DTC) was extracted from the SEER database. Among them, 30,872 patients underwent propensity score matching, and 15,436 received radioactive iodine (RAI) therapy. A significant difference in survival was observed between RAI-treated and non-RAI-treated patients (P < 0.0001). Following propensity score matching, Kaplan-Meier curves revealed that overall and cancer-specific survival rates were significantly higher in male DTC patients who received RAI treatment (P < 0.0001). In the multivariate Cox regression model, RAI therapy was identified as a significant and independent prognostic factor for improved survival in DTC (hazard ratio [HR] 0.55; 95% confidence interval [CI], 0.51-0.59). Further analysis of the prognostic value of RAI therapy in male DTC patients demonstrated that the benefits of RAI therapy increased significantly with larger tumor sizes, as follows: ≤ 1 cm (HR, 0.62; 95% CI, 0.52-0.73), > 1-2 cm (HR, 0.58; 95% CI, 0.51-0.67), > 2-4 cm (HR, 0.55; 95% CI, 0.48-0.63), and > 4 cm (HR, 0.45; 95% CI, 0.39-0.53).Our findings suggest that RAI treatment significantly improves survival outcomes in male patients with DTC, highlighting its therapeutic efficacy and potential benefits in clinical management. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13193-025-02373-x.