Simone De Leo, Giulia Brigante, Silvia D'Elia, Simona Censi, Bruno Madeo, Silvia Morelli, Alice Nervo, Andrea Repaci, Clotilde Sparano, Ilaria Stramazzo, Camilla Virili, Francesco Bertagna, Francesco Dondi, Efisio Puxeddu, Edoardo Talpacci, Maria Chiara Zatelli, Maria Rosaria Ambrosio, Francesco Felicetti, Alessandro Piovesan, Luisa Petrone, Virginia Adornato, Matteo Trevisan, Laura Fugazzola, Chiara Mele, Marco Zavattaro, Erica Solaroli, Nicola Salituro, Mattia Rossi, Loredana Pagano, Alessandra Colapinto, Cristina Basso, Graziano Ceresini, Michela Marina, Umberto Crocetti, Michela Massa, Maurilio Deandrea, Francesca Retta, Giovanna Spiazzi, Nicoletta Rolli, Rocco Bruno, Antonella Carbone, Mario Rotondi, Flavia Magri, Poupak Fallahi, Maria Grazia Chiofalo, Maria Giulia Santaguida, Salvatore Monti, Tommaso Porcelli, Roberto Castello, Alfonso Sagnella, Cristina Clausi, Giulia Di Dalmazi, Dario Tumino, Andrea Palermo, Antonio Brunetti, Andrea Lania, Andrea Liverani, Cosimo Durante, Umberto Ferraro Petrillo, Marco Alfo', Sebastiano Filetti, Giorgio Grani
{"title":"Prospective Validation of ATA Risk Score for Papillary Thyroid Microcarcinoma: An ITCO Real-World Study.","authors":"Simone De Leo, Giulia Brigante, Silvia D'Elia, Simona Censi, Bruno Madeo, Silvia Morelli, Alice Nervo, Andrea Repaci, Clotilde Sparano, Ilaria Stramazzo, Camilla Virili, Francesco Bertagna, Francesco Dondi, Efisio Puxeddu, Edoardo Talpacci, Maria Chiara Zatelli, Maria Rosaria Ambrosio, Francesco Felicetti, Alessandro Piovesan, Luisa Petrone, Virginia Adornato, Matteo Trevisan, Laura Fugazzola, Chiara Mele, Marco Zavattaro, Erica Solaroli, Nicola Salituro, Mattia Rossi, Loredana Pagano, Alessandra Colapinto, Cristina Basso, Graziano Ceresini, Michela Marina, Umberto Crocetti, Michela Massa, Maurilio Deandrea, Francesca Retta, Giovanna Spiazzi, Nicoletta Rolli, Rocco Bruno, Antonella Carbone, Mario Rotondi, Flavia Magri, Poupak Fallahi, Maria Grazia Chiofalo, Maria Giulia Santaguida, Salvatore Monti, Tommaso Porcelli, Roberto Castello, Alfonso Sagnella, Cristina Clausi, Giulia Di Dalmazi, Dario Tumino, Andrea Palermo, Antonio Brunetti, Andrea Lania, Andrea Liverani, Cosimo Durante, Umberto Ferraro Petrillo, Marco Alfo', Sebastiano Filetti, Giorgio Grani","doi":"10.1210/clinem/dgaf190","DOIUrl":null,"url":null,"abstract":"<p><strong>Context: </strong>The risk of recurrence of papillary thyroid carcinoma smaller than 1 cm (microPTC) is low. Predictors of disease persistence in microPTC are still unclear.</p><p><strong>Objective: </strong>To compare the clinical and pathological characteristics of microPTCs with macrocarcinomas (PTC > 1 cm), identifying the predictors of biochemical and structural incomplete response one year after initial treatment in microPTC.</p><p><strong>Methods: </strong>We included patients consecutively enrolled in the Italian Thyroid Cancer Observatory (NCT04031339), and selected patients with a histological diagnosis of PTC for whom complete pathological, clinical, treatment information, and results at the 1-year follow-up visits were available.</p><p><strong>Results: </strong>Among 5038 patients in the cohort, 2345 (46.5%) had a microPTC. Patients with microPTCs had tumors with more indolent pathological features: only 3% of patients were classified as high risk according to the American Thyroid Association (ATA) risk stratification system for persistent or recurrent disease and 1% had distant metastases at diagnosis. MicroPTCs had a significantly better outcome: only 5% had a biochemical (BIR) and 2.3% a structural incomplete (SIR) response. Distant metastases at diagnosis were the best predictor of SIR in microPTCs (OR 5.13, 95% CI 1.11-23.73, p=0.04). In a subgroup of 925 patients treated by total thyroidectomy and radioiodine treatment, the best predictor of SIR was the ATA high risk (OR 5.47, 95% CI 1.42-21.04, p=0.01).</p><p><strong>Conclusion: </strong>Our study confirms the favorable initial outcome of microPTC in a large series. We demonstrate that the ATA risk classification is reliable in predicting biochemical and structural persistence in microPTC patients. Distant metastases, although rare, remain the best predictor of structural persistence at 1-year follow-up. These findings underscore the importance of tailored management strategies based on comprehensive risk stratification, rather than solely on tumor size.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.0000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Endocrinology & Metabolism","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1210/clinem/dgaf190","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
Abstract
Context: The risk of recurrence of papillary thyroid carcinoma smaller than 1 cm (microPTC) is low. Predictors of disease persistence in microPTC are still unclear.
Objective: To compare the clinical and pathological characteristics of microPTCs with macrocarcinomas (PTC > 1 cm), identifying the predictors of biochemical and structural incomplete response one year after initial treatment in microPTC.
Methods: We included patients consecutively enrolled in the Italian Thyroid Cancer Observatory (NCT04031339), and selected patients with a histological diagnosis of PTC for whom complete pathological, clinical, treatment information, and results at the 1-year follow-up visits were available.
Results: Among 5038 patients in the cohort, 2345 (46.5%) had a microPTC. Patients with microPTCs had tumors with more indolent pathological features: only 3% of patients were classified as high risk according to the American Thyroid Association (ATA) risk stratification system for persistent or recurrent disease and 1% had distant metastases at diagnosis. MicroPTCs had a significantly better outcome: only 5% had a biochemical (BIR) and 2.3% a structural incomplete (SIR) response. Distant metastases at diagnosis were the best predictor of SIR in microPTCs (OR 5.13, 95% CI 1.11-23.73, p=0.04). In a subgroup of 925 patients treated by total thyroidectomy and radioiodine treatment, the best predictor of SIR was the ATA high risk (OR 5.47, 95% CI 1.42-21.04, p=0.01).
Conclusion: Our study confirms the favorable initial outcome of microPTC in a large series. We demonstrate that the ATA risk classification is reliable in predicting biochemical and structural persistence in microPTC patients. Distant metastases, although rare, remain the best predictor of structural persistence at 1-year follow-up. These findings underscore the importance of tailored management strategies based on comprehensive risk stratification, rather than solely on tumor size.
期刊介绍：
The Journal of Clinical Endocrinology & Metabolism is the world"s leading peer-reviewed journal for endocrine clinical research and cutting edge clinical practice reviews. Each issue provides the latest in-depth coverage of new developments enhancing our understanding, diagnosis and treatment of endocrine and metabolic disorders. Regular features of special interest to endocrine consultants include clinical trials, clinical reviews, clinical practice guidelines, case seminars, and controversies in clinical endocrinology, as well as original reports of the most important advances in patient-oriented endocrine and metabolic research. According to the latest Thomson Reuters Journal Citation Report, JCE&M articles were cited 64,185 times in 2008.
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