Dynamic Risk Stratification in Differentiated Thyroid Cancer

• Areas of Interest: Thyroid

Background: Differentiated thyroid cancer (DTC) is characterized by excellent prognosis when appropriate treatment is given. However, a significant degree of overtreatment still exists because of the inability to accurately identify small patient cohorts who experience a more aggressive form of the disease, often associated with certain poor prognostic factors. Identifying these cohorts at an early stage would allow patients at high risk to receive more aggressive treatment while avoiding unnecessary and invasive treatments in those at low risk.

Methods: Demographic, clinical, pathological, diagnostic, treatment, and follow-up data were recorded retrospectively for 549 DTC patients who had been consecutively recruited. Each cohort patient was classified in one out of four treatment response categories (according to the latest ATA GLs). Chi-square test and one-way ANOVA were used to evaluate the association of the prognostic factors with the categories of treatment response.

Results: Treatment response had a statistically significant association with histology, T and M stages, invasiveness, surgeons’ experience, Tg levels, and remnant score both during RAI and follow-up, and Tg-Ab levels during follow-up WBS.

Discussion: Most risk stratification systems include the same core parameters of age, tumor size, grade, presence of local invasion, and regional or distant metastases. Here, we discuss these common factors, as well as their association with treatment response, but also other upcoming markers including histology and multifocality of primary tumor, dose administered, and preparation method for radioiodine therapy (RAI), thyroglobulin (Tg), and antithyroglobulin antibodies (Tg-Ab) levels, both at initial management and during follow-up, and the presence of previously existing benign thyroid disease. A lack of definitive evidence continues to create confusion when conveying accurate prognostic information to the DTC patient population and when determining treatment regimen. In all cases, a combined multidisciplinary approach, with consideration of the available guidelines and stratification systems, should be utilized when planning an individualized treatment program including follow-up strategy, to offer the best care.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
10 May 2022