Tumor burden of persistent disease in patients with differentiated thyroid cancer: correlation with postoperative risk-stratification and impact on outcome

Background. Stimulated thyroglobulin levels measured at the time of remnant ablation (A-hTg) and BRAFV600E mutation had shown prognostic value in predicting persistent disease in differentiated thyroid cancer (DTC). The aim of this study was to evaluate the prognostic role of A-hTg combined with the BRAFV600E status in association with the revised American Thyroid Association (ATA) risk stratification. Material and Methods. 620 patients treated for a DTC were included in this study with a median follow-up duration of 6.1 years. All patients underwent total thyroidectomy followed by radioiodine ablation. Patients with positive anti-thyroglobulin antibodies were excluded. The predictive value of A-hTg was calculated by receiver operating characteristic curve (ROC curve) analysis. The Cox proportional hazard regression model, including the BRAF status, A-hTg, and ATA classification system, was assessed to evaluate the existing persistent disease risk. Results. Taken together, the BRAF status and A-hTg levels improve the ATA risk classification in all categories. In particular, in the low-risk ATA classification, only the combination of BRAFV600E+A-hTg>8.9ng/ml was associated with persistent disease (P=0.001, HR 60.2, CI 95% 5.28-687). In the intermediate-risk ATA classification, BRAFWT+A-hTg>8.9ng/ml was associated with persistent disease (P=0.029, HR 2.71, CI 95% 1.106-6.670) and BRAFV600E+A-hTg>8.9ng/ml was also associated with persistent disease (P<0.001, HR 5.001, CI 95% 2.318-10.790). In the high-risk ATA classification, both BRAFV600E+A-hTg<8.9ng/ml and BRAFV600E+A-hTg>8.9 ng/ml were associated with persistent disease (P=0.042, HR 5.963, CI 95% 1.069-33.255 and P=0.002, HR 11.564, CI 95% 2.543-52.576, respectively). Conclusions. The BRAF status and stimulated thyroglobulin levels at ablation time improve the ATA risk stratification of differentiated thyroid cancer; therefore, even A-hTg could be included in risk classification factors.

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Validation of dynamic risk stratification in pediatric differentiated thyroid cancer

Endocrine ◽

10.1007/s12020-017-1381-7 ◽

2017 ◽

Vol 58 (1) ◽

pp. 167-175 ◽

Cited By ~ 7

Author(s):

Seo Young Sohn ◽

Young Nam Kim ◽

Hye In Kim ◽

Tae Hyuk Kim ◽

Sun Wook Kim ◽

...

Keyword(s):

Thyroid Cancer ◽

Risk Stratification ◽

Differentiated Thyroid Cancer ◽

Dynamic Risk

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ASO Author Reflections: Preoperative Risk Stratification in Differentiated Thyroid Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-018-7057-6 ◽

2018 ◽

Vol 25 (S3) ◽

pp. 878-879

Author(s):

Kyle Zanocco

Keyword(s):

Thyroid Cancer ◽

Risk Stratification ◽

Differentiated Thyroid Cancer ◽

Preoperative Risk ◽

Preoperative Risk Stratification

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The Influence of Age on Disease Outcome in 2015 ATA High Risk Differentiated Thyroid Cancer Patients

Acta Endocrinologica ◽

10.1530/eje-21-0365 ◽

2021 ◽

Author(s):

Evert F.s. van Velsen ◽

Robin P. Peeters ◽

Merel T. Stegenga ◽

F.j. van Kemenade ◽

Tessa M. van Ginhoven ◽

...

Keyword(s):

Thyroid Cancer ◽

High Risk ◽

Risk Stratification ◽

Differentiated Thyroid Cancer ◽

Response To Therapy ◽

Disease Outcome ◽

High Risk Patients ◽

Risk Patients ◽

Stratification System ◽

Risk Stratification System

Objective Recent research suggests that the addition of age improves the 2015 American Thyroid Association (ATA) Risk Stratification System for differentiated thyroid cancer (DTC). The aim of our study was to investigate the influence of age on disease outcome in ATA High Risk patients with a focus on differences between patients with papillary (PTC) and follicular thyroid cancer (FTC). Methods We retrospectively studied adult patients with High Risk DTC from a Dutch university hospital. Logistic regression and Cox proportional hazards models were used to estimate the effects of age (at diagnosis) and several age cutoffs (per five years increment between 20 and 80 years) on (i) response to therapy, (ii) developing no evidence of disease (NED), (iii) recurrence, and (iv) disease specific mortality (DSM). Results We included 236 ATA High Risk patients (32% FTC) with a median follow-up of 6 years. Age, either continuously or dichotomously, had a significant influence on having an excellent response after initial therapy, developing NED, recurrence, and DSM for PTC and FTC. For FTC, an age cutoff of 65 or 70 years showed the best statistical model performance, while this was 50 or 60 years for PTC. Conclusions In a population of patients with High Risk DTC, older age has a significant negative influence on disease outcomes. Slightly different optimal age cutoffs were identified for the different outcomes, and these cutoffs differed between PTC and FTC. Therefore, the ATA Risk Stratification System may further improve should age be incorporated as an additional risk factor.

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Incidence and dynamic risk stratification in differentiated thyroid cancer in a high-resolution clinic, 2002–2017

Endocrinología Diabetes y Nutrición (English ed ) ◽

10.1016/j.endien.2021.11.021 ◽

2021 ◽

Author(s):

Gonzalo Díaz-Soto ◽

Beatriz Torres Torres ◽

Juan José López ◽

Susana García ◽

María Álvarez Quiñones ◽

...

Keyword(s):

Thyroid Cancer ◽

High Resolution ◽

Risk Stratification ◽

Differentiated Thyroid Cancer ◽

Dynamic Risk

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Risk Stratification in Differentiated Thyroid Cancer: Importance and Clinical Implications of Preoperative Risk Stratification

VideoEndocrinology ◽

10.1089/ve.2018.0140 ◽

2018 ◽

Vol 5 (4) ◽

Cited By ~ 1

Author(s):

R. Michael Tuttle

Keyword(s):

Thyroid Cancer ◽

Risk Stratification ◽

Differentiated Thyroid Cancer ◽

Clinical Implications ◽

Preoperative Risk ◽

Preoperative Risk Stratification

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BRAF mutation and age in differentiated thyroid cancer risk stratification: Two sides of the same coin

Oral Oncology ◽

10.1016/j.oraloncology.2020.104732 ◽

2020 ◽

Vol 106 ◽

pp. 104732

Author(s):

Anand Subash ◽

Piyush Sinha ◽

Abhijeet Singh

Keyword(s):

Thyroid Cancer ◽

Cancer Risk ◽

Risk Stratification ◽

Braf Mutation ◽

Differentiated Thyroid Cancer ◽

Thyroid Cancer Risk ◽

Two Sides

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Preoperative Serum Thyroglobulin and Its Correlation with the Burden and Extent of Differentiated Thyroid Cancer

Cancers ◽

10.3390/cancers12030625 ◽

2020 ◽

Vol 12 (3) ◽

pp. 625

Author(s):

Hosu Kim ◽

So Young Park ◽

Jun-Ho Choe ◽

Jee Soo Kim ◽

Soo Yeon Hahn ◽

...

Keyword(s):

Thyroid Cancer ◽

Primary Tumor ◽

Differentiated Thyroid Cancer ◽

Medical Center ◽

Distant Metastases ◽

Predictive Biomarker ◽

Tumor Burden ◽

Serum Thyroglobulin ◽

Preoperative Serum ◽

Clinical Records

Lymph node metastasis (LNM) in differentiated thyroid cancer (DTC) is usually detected with preoperative ultrasonography; however, this has limited sensitivity for small metastases, and there is currently no predictive biomarker that can help to inform the extent of surgery required. We evaluated whether preoperative serum thyroglobulin levels can predict tumor burden and extent. We retrospectively reviewed the clinical records of 4029 DTC cases diagnosed and treated at a Samsung Medical Center between 1994 and 2016. We reviewed primary tumor size, number and location of LNM, and presence of distant metastases to reveal relationships between tumor burden and extent and preoperative serum thyroglobulin levels. We found a linear association between increasing preoperative thyroglobulin levels, the size of the primary tumor, and the number of LNM (r = 0.34, p < 0.001, r = 0.20, p < 0.001, respectively). Tumor extent also increased with each decile of increasing preoperative thyroglobulin level (r = 0.18, p < 0.001). Preoperative thyroglobulin levels of 13.15 ng/mL, 30.05 ng/mL, and 62.9 ng/mL were associated with the presence of ipsilateral lateral LNM, contralateral lateral LNM, and distant metastasis, respectively. Our results suggest that preoperative measurement of serum thyroglobulin may help to predict LNM and help to tailor surgery.

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