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.
