Modified dynamic risk stratification for predicting recurrence using the response to initial therapy in patients with differentiated thyroid carcinoma

• Published in: European journal of endocrinology Vol. 170; no. 1; pp. 23 - 30
• Main Authors: Jeon, Min Ji, Kim, Won Gu, Park, Woo Ri, Han, Ji Min, Kim, Tae Yong, Song, Dong Eun, Chung, Ki-Wook, Ryu, Jin-Sook, Hong, Suck Joon, Shong, Young Kee, Kim, Won Bae
• Format: Journal Article
• Language: English
• Published: Bristol Bioscientifica Ltd 01-01-2014; BioScientifica
• Subjects: Adult; Autoantibodies - analysis; Biological and medical sciences; Carcinoma - diagnosis; Carcinoma - prevention & control; Carcinoma - radiotherapy; Carcinoma - surgery; Clinical Study; Cohort Studies; Endocrinopathies; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Humans; Iodine Radioisotopes - therapeutic use; Male; Malignant tumors; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - prevention & control; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Precision Medicine - methods; Prognosis; Radiopharmaceuticals - therapeutic use; Radiotherapy, Adjuvant; Risk Assessment; Secondary Prevention; Survival Analysis; Thyroid Neoplasms - diagnosis; Thyroid Neoplasms - prevention & control; Thyroid Neoplasms - radiotherapy; Thyroid Neoplasms - surgery; Thyroid. Thyroid axis (diseases); Thyroidectomy; Vertebrates: endocrinology; Endocrinopathy; Human; Relapse; Thyroid diseases; Patient; Risk; Malignant tumor; Thyroid carcinoma; Treatment; Dynamics; Risk factor; Predictive factor; Stratification; Endocrinology; Cancer
• ISSN: 0804-4643; 1479-683X
• DOI: 10.1530/EJE-13-0524

ObjectiveA new risk stratification system was proposed to estimate the risk of recurrence in patients with differentiated thyroid carcinoma (DTC) using the response to initial therapy. Here, we describe the modified dynamic risk stratification system, which takes into consideration the status of serum anti-Tg antibody (TgAb), and validate this system for assessing the risk of recurrence in patients with DTC.Patients and methodsPatients who underwent total thyroidectomy with radioiodine remnant ablation due to DTC between 2000 and 2005 were included. We classified patients into four groups based on the response to the initial therapy (‘excellent’, ‘acceptable’, ‘biochemical incomplete’, and ‘structural incomplete’ response).ResultsThe median follow-up period of 715 patients with DTC was 8 years. The response to initial therapy was an important risk predictor for recurrent/persistent DTC. The relative risks (95% CI) of recurrence were 16.5 (6.3–43.0) in the ‘acceptable response’ group, 41.3 (15.4–110.8) in the ‘biochemical incomplete response’ group, and 281.2 (112.9–700.5) in the ‘structural incomplete response’ group compared with the ‘excellent response’ group (P<0.001, P<0.001, and P<0.001 respectively). The disease-free survival rate of the ‘excellent response’ group to initial therapy was 98.3% whereas that of the ‘structural incomplete response’ group was only 6.8%.ConclusionsOur study validates the usefulness of the modified dynamic risk stratification system including the status of serum TgAb for predicting recurrent/persistent disease in patients with DTC. Personalized risk assessment using the response to initial therapy could be useful for the follow-up and management of patients with DTC.