Dynamic Risk Stratification for Predicting Recurrence in Patients with Differentiated Thyroid Cancer Treated Without Radioactive Iodine Remnant Ablation Therapy

Abstract

The new DRS system was effective for predicting risk of recurrent/persistent disease in patients with DTC who underwent lobectomy or total thyroidectomy without RAI remnant ablation.

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

“…The differences in DFS regarding treatment responses were statistically significant. The relative risk (RR) of DTC relapse among patients with an indeterminate response was nearly 2 times higher, with a biochemical incomplete response nearly 21 times higher and with a structural incomplete response nearly 243 times higher comparing to patients showing and an excellent response (Park et al 2017).…”

“…The results of the second study have just been published (Park et al 2017). The authors retrospectively analyzed a group of 357 DTC patients after lobectomy or TT.…”

“…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.…”

Impact of historic histopathologic sample review on the risk of recurrence in patients with differentiated thyroid cancer

“…As a result, the low risk category was expanded to include patients with small-volume lymph node metastases (clinical N0 or < 5 pathologic N1 micrometastases, < 0.2 cm in the largest dimension), the intermediate RR group now considers only a subset of patients with lymph node metastases (clinical N1 or > 5 pathologic N1 with all involved lymph nodes < 3 cm in the largest dimension), and a second group, with intermediate to high risk of recurrence, now includes those cases with large-volume lymph node involvement (any metastatic lymph node > 3 cm in the largest dimension, > 3 lymph node metastasis with extranodal extension) and FTC with extensive vascular invasion (> 4 foci of vascular invasion or extracapsular vascular invasion). The 2015 guidelines defined this new version of the RR as the "modified risk stratification system from ATA 2009 guidelines" (MRSS ATA 2009) and were validated by our and other groups around the world in ablated and non-ablated patients (11)(12)(13)(14).…”