Dynamic prediction of the risk of recurrence in patients over 60 years of age with differentiated thyroid carcinoma

Abstract

Objective: The reclassification of the risk according to the response to the initial treatment makes the treatment of differentiated thyroid cancer (DTC) vary in each individual. As the influence of age on this diagnostic strategy is unknown, we have decided to assess it in adults who are over 60 years of age. Subjects and methods: Ninety patients with DTC above 60 years old were enrolled, with total thyroidectomy plus radioiodine ablation, negative anti-thyroglobulin antibodies, follow-up ≥ 2 years and with clinical and pathological information to classify the risk of recurrence according to ATA (American Thyroid Association) and reclassify based on the response to initial therapy according to MSKCC (Memorial Sloan Kettering Cancer Center). The structural persistence at the end of the follow-up was the gold standard of our analysis. Results: The structural persistence in ATA low, intermediate and high risk categories was 0, 38, and 100%, respectively. In the intermediate group, none of those with an excellent response to the initial treatment showed structural persistence, whereas 39% of those with an incomplete/indeterminate response showed structural persistence (p < 0.01). Conclusions: The re-stratification according to the response to the initial treatment in patients over 60 years of age with an ATA intermediate risk of recurrence allowed for the distinction of disease-free patients at the end of the follow-up from those with structural persistence and a worse clinical progression. Arch Endocrinol Metab. 2016;60(4):348-54

Dynamic risk stratification in the follow-up of thyroid cancer: what is still to be discovered in 2017?

“…Recently, a dynamic prediction of the risk of recurrence has been applied in a group of older DTC patients above the age of 60 years (Morosán et al 2016). Ninety patients at median age of 65 years (range 62-82), treated with total thyroidectomy and RAI ablation between 2000 and 2013, and with follow-up period longer than 2 years, were included into a retrospective analysis.…”

“…Considering ATA intermediate-risk group 61% of patients were free of disease and 39% had persistent disease. When this group was restratified 2 years later using response criteria, 100% of patients with an excellent response and only 61% of subjects with indeterminate/incomplete responses were disease free at final follow-up (Morosán et al 2016).…”

“…The time, when the treatment response was evaluated varies across the studies (Table 3). In some papers the authors analyzed all clinical data obtained during first 2 years of follow-up to assess treatment response (Tuttle et al 2010, Momesso et al 2016, Park et al 2017, whereas the others carried out risk restratification in different single time points between 8 and 24 months after initial therapy (Castagna et al 2011, Jeon et al 2014, Kowalska et al 2016, Morosán et al 2016. One may ask the question which data are more accurate for risk restratification: these collected during the first 2 years of follow-up or those obtained during single assessment between 8 and 24 months after initial therapy?…”

“…The number of follow-up visits and diagnostic examinations may influence the diagnosis of cancer recurrence. Considering outcome variables, some of papers analyzed the percentage of patients with NED or persistent disease, recurrence rates, and the number of cancer-related deaths (Tuttle et al 2010, Castagna et al 2011, Kowalska et al 2016, Morosán et al 2016, Momesso et al 2016, Park et al 2017, whereas other studies performed PFS or DFS analyses , Jeon et al 2014, Tavarelli et al 2017) to compare the patients with different stages of initial stratification or treatment response. We have to be aware that important limitation of PFS or DFS is how closely patients are followed.…”