Dynamic Risk Stratification in Stage I Papillary Thyroid Cancer Patients Younger than 45 Years.

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Dynamic Risk Stratification in Stage I Papillary Thyroid Cancer Patients Younger than 45 Years.

Thyroid. 2017 Aug 28;:

Authors: Sung TY, Cho JW, Lee YM, Lee YH, Kwon H, Jeon M, Kim WG, Choi YJ, Song DE, Chung KW, Yoon JH, Hong SJ

Abstract
BACKGROUND: This study validated the dynamic risk stratification (DRS) system with regard to its association with structural recurrence and risk factors associated with non-excellent responses in patients with stage I classical papillary thyroid cancer (PTC) younger than 45 years.
METHODS: This historical cohort study included 598 patients with stage I classical PTC under the age of 45 years treated with total thyroidectomy followed by radioactive iodine (RAI) remnant ablation (n = 440), total thyroidectomy without RAI remnant ablation (n = 23), and thyroid lobectomy alone (n = 135).
RESULTS: The median follow-up period was 123 months. Structural recurrence occurred in 4.2% of the patients with excellent response (n = 18/432), 17.1% of patients with indeterminate response (n = 18/105), 44.7% of patients with biochemically incomplete response (n = 17/38), and 82.6% of patients with structurally incomplete response (n = 19/23) (p < 0.001) during the follow up. The disease-free survival curves of each response showed significant differences (p < 0.001). Extensive extrathyroidal extension and extranodal extension were the independent risk factors associated with non-excellent response (p < 0.05).
CONCLUSIONS: DRS may reduce unnecessary additional treatments by re-classifying initial risk estimates of structural recurrence. Furthermore, applying the risk factors associated with non-excellent response to initial therapy may be a more useful and viable surrogate of the risk for structural recurrence in stage I PTC patients younger than 45 years.

PMID: 28847226 [PubMed - as supplied by publisher]

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