Abstract
ContextThere has been a marked increase in the detection of differentiated thyroid carcinoma (DTC) over the past few years, which has improved the prognosis. However, it is necessary to adjust treatment and monitoring strategies relative to the risk of an unfavourable disease course.Materials and MethodsThis retrospective study examined data from 916 patients with DTC who received treatment at a single centre between 2000 and 2013. The utility of the American Thyroid Association (ATA) and the European Thyroid Association (ETA) recommended systems for early assessment of the risk of recurrent/persistent disease was compared with that of the recently recommended delayed risk stratification (DRS) system.ResultsThe PPV and NPV for the ATA (24.59% and 95.42%, respectively) and ETA (24.28% and 95.68%, respectively) were significantly lower than those for the DRS (56.76% and 98.5%, respectively) (p<0.0001). The proportion of variance for predicting the final outcome was 15.8% for ATA, 16.1% for ETA and 56.7% for the DRS. Recurrent disease was rare (1% of patients), and was nearly always identified in patients at intermediate/high risk according to the initial stratification (9/10 cases).ConclusionsThe DRS showed a better correlation with the risk of persistent disease than the early stratification systems and allows personalisation of follow-up. If clinicians plan to alter the intensity of surveillance, patients at intermediate/high risk according to the early stratification systems should remain within the specialized centers; however, low risk patients can be referred to endocrinologists or other appropriate practitioners for long-term follow-up, as these patients remained at low risk after risk re-stratification.
Highlights
The incidence of differentiated thyroid carcinoma (DTC) is rapidly increasing
The positive predictive value (PPV) and negative predictive value (NPV) for the American Thyroid Association (ATA) (24.59% and 95.42%, respectively) and European Thyroid Association (ETA) (24.28% and 95.68%, respectively) were significantly lower than those for the delayed risk stratification (DRS) (56.76% and 98.5%, respectively) (p
If clinicians plan to alter the intensity of surveillance, patients at intermediate/high risk according to the early stratification
Summary
The incidence of differentiated thyroid carcinoma (DTC) is rapidly increasing. Over the past 30 years, the incidence in the United States has tripled from 4.9 to 14.3 per 100,000 inhabitants [1]. The Union for International Cancer Control-American Joint Committee on Cancer (UICC-AJCC) staging system for thyroid carcinoma, which is based on histopathology results and the patient’s age, shows a good correlation with the risk of mortality; it does not predict the risk of recurrence [13]. The superiority of a new system proposed by Tuttle [14], called the “ongoing risk stratification” system, has become clear. This system takes account of changes in the initial risk level according to data obtained after completion of initial treatment. The new system has been validated by other authors [15,16,17,18,19,20]
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