Abstract
Simple SummaryIn this study, we have identified and validated a large series of patients affected by DTC, and created a three-domain scoring system able to identify the risk of persistence-relapse of disease after initial treatment (e.g., thyroidectomy and RAI). This three-domain system includes potential prognostic factors such as demographic (age and gender) and RAI-related (pre-RAI Tg levels and the post-therapeutic 131I WBS) data. This score is easy to calculate and interpret, as it provides a score ranging from 0 to 100; it allows clinicians to identify those patients who need stricter clinical surveillance or proper treatment due to a risk of disease persistence/relapse. This prognostic system can be used to semi-quantify the recurrence risk.Purpose: the validation of a new scoring model considering the principal risk factors of differentiated thyroid cancer (DTC) relapse. Methods: we evaluated all DTC patients treated with thyroidectomy and radioactive iodine (RAI) therapy. Three domains were considered: the demographic domain (age and gender), the surgical domain (histology and the American Thyroid Association risk categories), and the RAI-related domain (pre-RAI thyroglobulin and post-therapeutic 131I whole-body scan). The progression-free survival was assessed. The patients’ sample was randomly split into a training and validation set. The three-domain score was calculated as the weighted sum of the levels of each significant factor, then scaled to an integer range (0–100) and, finally, stratified into terciles: mild risk 0–33, moderate risk 34–66, and severe risk 67–100. Results: 907 DTC patients were included. The RAI-related domain was the most relevant factor in the score calculation. The tercile stratification identified significantly different survival curves: patients within the two upper terciles showed approximately 6 to 30 times more progressive risk than patients at mild risk. Conclusion: we have validated a three-domain scoring system and the principal impact on this score is provided by the peri-RAI findings, whose prognostic role seems to be essential in risk identification.
Highlights
differentiated thyroid cancer (DTC) with gross extra-thyroidal extension are considered at high risk of recurrence, intraglandular DTCs with non-aggressive histological features are considered as low-risk, while the remaining DTCs are categorized as intermediate-risk DTCs
Since we considered that each domain included at least two risk factors describing one disease dimension, a three-domain model was designed, including the demographic, the surgical, and the radioactive iodine (RAI)-related patients’ aspects
We have identified and validated a large series of patients affected by DTC, and created a three-domain scoring system able to identify the risk of the persistence/relapse of disease after the standard upfront treatment, consisting of total thyroidectomy and RAI
Summary
Negatively impact the overall quality of life of these subjects [7] For these reasons, it is pivotal to obtain an accurate assessment of the DTC aggressiveness at the time of diagnosis and directly follow this with the necessary treatment. The ATA systems proposed in 2009 [11] and amended in 2015 [6] appear to be an easy-to-use tool to assess patients’ risk of relapse [12].
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