Tracking dynamic evolution of low- and intermediate-risk differentiated thyroid cancer: Identification of individuals at risk of recurrence

IF 3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Clinical Endocrinology Pub Date : 2024-07-22 DOI:10.1111/cen.15111

Federico Volpi, Juan Alcalde, Javier Larrache, Estíbaliz Alegre, Allan Argueta, María D. Lozano, Carla Colombo, Juan C. Galofré

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Abstract

Objective

The generally good prognosis of low- and intermediate-risk differentiated thyroid cancer (DTC) underscored the need to identify those few patients who relapse.

Design

Records of 299 low- or intermediate-risk DTC patients (mean follow-up 8.2 ± 6.2 years) were retrospectively reviewed. The sample was classified following the American Thyroid Association (ATA) dynamic risk stratification (DRS) system.

Patients and Measurement

After classifying patients according to DRS at the first visit following initial therapy (FU1), structural recurrence occurred in 2/181 (1.1%), 5/81 (6.2%) and 13/26 (50.0%) with excellent, indeterminate and biochemical incomplete response to treatment, respectively. All relapses but one happened within 5 years from FU1. Univariate analysis comparing excellent, indeterminate and biochemical incomplete with structural incomplete responses at the end of the follow-up, identified tumour size (p < .001), T status (<0.001), positive lymph nodes (N) (p < .01), multifocality (p < .004), need of additional radioactive iodine (RAI) (p < .0001) and first DRS status (p < .0003) as risk factors of recurrence. In the multivariate analysis, only RAI remained statistically significant (p < .02). Comparison between excellent and indeterminate with biochemical and structural incomplete responses, identified tumour size (p < .0004), T (p < .01), N (p < .0001), bilaterality (p < .03), first DRS status (p < .0001) and RAI (p < .001) as recurrence risk factors. T (p < .01) and first DRS (p < .0006) were confirmed in the multivariate analysis.

Conclusions

Patients with DTC classified as low- or intermediate-risk of recurrence with excellent response to treatment at FU1 rarely develop structural disease and this occurs almost exclusively in the first 5 years. Initial DRS status is an accurate tool for determining the risk of recurrence.

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跟踪低危和中危分化型甲状腺癌的动态演变：识别有复发风险的个体

目的低危和中危分化型甲状腺癌（DTC）的预后普遍较好，因此有必要找出少数复发患者：设计：回顾性研究了299例低危或中危DTC患者的病历（平均随访时间为8.2 ± 6.2年）。样本按照美国甲状腺协会（ATA）动态风险分层（DRS）系统进行分类：在初始治疗后首次就诊（FU1）时根据 DRS 对患者进行分类后，结构性复发分别发生在 2/181（1.1%）、5/81（6.2%）和 13/26（50.0%）例患者中，这些患者对治疗的反应分别为良好、不确定和生化反应不完全。除一次复发外，所有复发均发生在自FU1起的5年内。单变量分析比较了随访结束时的极佳反应、不确定反应、生化不完全反应和结构不完全反应，确定了肿瘤大小（P 结论：肿瘤大小越小，治疗效果越好：被归类为低危或中危复发的 DTC 患者在 FU1 时对治疗反应良好，但很少出现结构性疾病，而且这种情况几乎只发生在前 5 年。初始 DRS 状态是确定复发风险的准确工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Endocrinology 医学-内分泌学与代谢

CiteScore

6.40

自引率

3.10%

发文量

192

审稿时长

1 months

期刊介绍： Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.

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