The Initial ATA Risk Classification, but Not the AJCC/TNM Stage, Predicts the Persistence or Relapse of Differentiated Thyroid Cancer in Long-Term Surveillance

Abstract

Background: The American Joint Commission on Cancer on Tumor Node Metastasis (AJCC/TNM) staging system provides adequate information on the risk of differentiated thyroid cancer (DTC)-specific mortality in totally thyroidectomized patients, but its role in predicting persistence and relapse of disease is uncertain. The relatively new 2015 American Thyroid Association (ATA) guidelines recommend stratifying patients at the time of DTC diagnosis with its own risk classification system, in order to identify those at high risk of residual or recurrent morbidity who may benefit from post-operative radioiodine (RAI) administration and/or need additional work-up. Methods: To verify the prevalence proportion of persistence or relapse of disease, a consecutive cohort of 152 patients with a diagnosis of DTC, subjected to total thyroidectomy (+/− post-operative RAI administration as per guidelines indication) and to neck ultrasonography (US), as well as biochemical surveillance for a minimum of 2 years at the Endocrinology Unit of Mater-Domini Hospital (Catanzaro, Italy), was enrolled. The prognostic role of the AJCC/TNM stage and ATA risk classification system was analyzed by logistic regression. Results: At a mean of 9 years after surgical treatment, DTC was found to persist or relapse in 19 (12.5%) participants. The initial risk for these outcomes, based on the ATA classification, was mostly low (53.9%) or intermediate (39.5%). AJCC/TNM stages were predominantly stage I or stage II. Despite a small representation in this cohort, high-risk patients according to the ATA classification had 8-fold higher odds of persistence or relapse of disease than those of low-risk participants, while controlling for potential risk modifiers, including age at DTC diagnosis, male gender, and post-operative RAI administration (p = 0.008). In contrast, the AJCC/TNM stage was not associated with the disease status at the last follow-up visit (p = 0.068 for the 7th Edition; p = 0.165 for the 8th Edition). Furthermore, low-risk participants subjected to post-operative RAI administration had the same probability of persistence or relapse of DTC when compared to those who had undergone total thyroidectomy only. Conclusions: There is a need for the endocrine community to revise the current work-up of DTC. The initial ATA risk classification is a reliable tool for predicting the persistence or relapse of disease in long-term surveillance.

Incidental thyroid carcinoma in an endemic goiter area in Italy: histopathological features and predictors of a common finding

“…The decision regarding postoperative treatment was primarily informed by the histopathological findings. In accordance with current guidelines, patients with T1a (as per the AJCC/TNM stage [ 3 ]) follicular epithelial-derived thyroid carcinoma, NIFTP, or UMP were not administered radioiodine metabolic therapy [ 26 ]. On the other hand, radioiodine metabolic therapy was recommended for all other patients with T1b-T3a thyroid carcinoma of follicular origin.…”

“…Additionally, it is worth acknowledging that being male has been linked to a worse prognosis in patients with thyroid carcinomas [ 54 – 56 ]. Although the present work does not primarily focus on the prognosis of ITC, previous findings from our own group indicate a higher occurrence of both benign and malignant nodules in Calabria among females compared to males (approximately 3:1 ratio) [ 24 ], with males tending to have a higher risk of persistent or recurrent malignant disease in non-incidental tumor cases [ 3 ]. No specific sex-related issues have emerged during the postoperative follow-up of ITC in this study, and it remains unclear whether being female could be regarded as a favorable prognostic factor.…”

“…As part of this process, the study investigators revisited the diagnosis of ITC by reviewing the original samples. Whenever available, clinical information pertaining to the long-term instrumental and biochemical follow-up monitoring of individuals diagnosed with ITC was also collected, as described elsewhere [ 3 ]. The study was carried out in order to ensure the anonymity of the participants and adhere to the guidelines outlined in the Declaration of Helsinki, as well as the principles of Good Clinical Practice.…”

“…The prevalence of thyroid cancer has significantly increased in the past few decades globally, although the rates of increase vary among different populations [ 2 ]. It has been observed that this rapid increase specifically applies to papillary thyroid cancer (PTC), which is the most common subtype of thyroid carcinoma and is often discovered incidentally in an indolent form [ 3 ]. Various factors, including iodination programs in areas with low iodine intake, ultrasonographic screening in regions with a high prevalence of goiter, the growing use of fine-needle aspiration biopsy (FNAB), and the thorough examination of the removed thyroid tissue, as well as environmental factors like obesity, have been linked to the rising rates of both micro (maximum diameter ≤10 mm) and macro (maximum diameter >10 mm) PTC [ 4 – 7 ].…”

Importancia del manejo multidisciplinario en el paciente con cáncer de tiroides diferenciado

“…Esto se puede realizar mediante una combinación de varias herramientas y técnicas de diagnóstico, que incluyen: examen físico del paciente en busca de signos de nódulo tiroideo, análisis de sangre para evaluar los niveles hormonales del paciente, estudios de imagen que se pueden usar para crear imágenes detalladas de la glándula tiroides e identificar cualquier nódulo tiroideo, aspiración por aguja fina (DNA) y biopsia donde se toma una pequeña muestra del nódulo o tejido, se examina bajo un microscopio y nos ayuda a determinar si el nódulo es canceroso. Si el nódulo o tejido examinado resulta canceroso, nos podemos apoyar de las pruebas de estadificación para determinar la extensión del cáncer y si se ha propagado a otras partes del cuerpo, siendo el sistema de estadificación TNM el propuesto por la American Thyroid Association (ATA) para realizarlo (Wang S. et al, 2022& Giuliano S., 2022.…”