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

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.

scholarly journals Prognostic analysis and beneficiary identification of adjuvant external beam radiotherapy for stage pT4b sigmoid colon cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yaobin Lin ◽  
Lei Wang ◽  
Lingdong Shao ◽  
Xueqing Zhang ◽  
Huaqin Lin ◽  
...  
Keyword(s):  
Colon Cancer ◽  
High Risk ◽  
Risk Stratification ◽  
Sigmoid Colon ◽  
External Beam Radiotherapy ◽  
Sigmoid Colon Cancer ◽  
High Risk Patients ◽  
Risk Patients ◽  
Stratification System ◽  
Risk Stratification System

AbstractThe clinical efficacy of adjuvant radiotherapy in sigmoid colon cancer remains questioned. To evaluate the clinical efficacy of adjuvant external beam radiotherapy (EBRT) for patients with pathologic stage T4b sigmoid colon cancer. Patients with stage pT4b sigmoid colon cancer receiving adjuvant EBRT or not followed by surgery between 2004 and 2016 were extracted from the Surveillance, Epidemiology, and End Results database. Analysis of overall survival (OS) was performed using Kaplan–Meier curves and prognostic factors were identified using Cox proportional hazards regression models with 95% confidence intervals within the entire cohort. A risk-stratification system was then developed based on the β regression coefficient. Among 2073 patients, 284 (13.7%) underwent adjuvant EBRT. The median OS in the group receiving adjuvant EBRT was significantly longer than that in the non-radiotherapy group (p < 0.001). Age, serum carcinoembryonic antigen (CEA) level, perineural invasion, lymph node dissection (LND) number, and adjuvant EBRT were independent factors associated with OS. A risk‐stratification system was generated, which showed that low‐risk patients had a higher 5-year survival rate than high-risk patients (75.6% vs. 42.3%, p < 0.001). Adjuvant EBRT significantly prolonged the 5-year survival rate of high-risk patients (62.6% vs. 38.3%, p = 0.009) but showed no survival benefit among low‐risk patients (87.7% vs. 73.2%, p = 0.100). Our risk‐stratification model comprising age, serum CEA, perineural invasion, and LND number predicted the outcomes of patients with stage pT4b sigmoid colon cancer based on which subgroup of high-risk patients should receive adjuvant EBRT.

Prognostic implications of pre-ablation stimulated Tg: a retrospective analysis of 2500 thyroid cancer patients

2021 ◽  
Author(s):  
Tian Tian ◽  
Yangmengyuan Xu ◽  
Xinyue Zhang ◽  
Bin Liu
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Risk Stratification ◽  
Clinical Outcomes ◽  
Recurrent Disease ◽  
Clinicopathological Parameters ◽  
Characteristic Analysis ◽  
High Risk Patients ◽  
Risk Patients ◽  
Risk Categories

Abstract Context The risk of persistent and recurrent disease in patients with differentiated thyroid cancer (DTC) is a continuum that ranges from very low to very high, even within the three primary risk categories. It is important to identify independent clinicopathological parameters to accurately predict clinical outcomes. Objective To examine the association between pre-ablation stimulated thyroglobulin (ps-Tg) and persistent and recurrent disease in DTC patients and investigate whether incorporation of ps-Tg could provide a more individualized estimate of clinical outcomes. Design, Setting, and Participants Medical records of 2524 DTC patients who underwent total thyroidectomy and radioiodine ablation between 2006 and 2018 were retrospectively reviewed. Main Outcome Measure Ps-Tg was measured under thyroid hormone withdrawal before remnant ablation. Association of ps-Tg and clinical outcomes. Results In multivariate analysis, age, ATA risk stratification, M1, ps-Tg and cumulative administered activities were the independent predictive factors for persistent/ recurrent disease. Receiver operating characteristic analysis identified ps-Tg cutoff (≤ 10.1 ng/mL) to predict disease free status with a negative predictive value of 95%, and validated for all ATA categories. Integration of ps-Tg into ATA risk categories indicated that the presence of ps-Tg ≤ 10.1 ng/mL was associated with a significantly decreased chance of having persistent/recurrent disease in intermediate- and high-risk patients (9.9 to 4.1% in intermediate-risk patients, and 33.1 to 8.5% in high-risk patients). Conclusion Ps-Tg (≤ 10.1 ng/mL) was a key predictor of clinical outcomes in DTC patients. Its incorporation as a variable in the ATA risk stratification system could more accurately predict clinical outcomes.

scholarly journals Efficacy of Dosimetric Versus Empiric Prescribed Activity of 131I for Therapy of Differentiated Thyroid Cancer

2011 ◽  
Vol 96 (10) ◽  
pp. 3217-3225 ◽  
Author(s):  
Joanna Klubo-Gwiezdzinska ◽  
Douglas Van Nostrand ◽  
Frank Atkins ◽  
Kenneth Burman ◽  
Jacqueline Jonklaas ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Side Effects ◽  
High Risk ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Differentiated Thyroid Cancer ◽  
Progression Free Survival ◽  
Response To Treatment ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background: The optimal management of high-risk patients with differentiated thyroid cancer (DTC) consists of thyroidectomy followed by radioiodine (131I) therapy. The prescribed activity of 131I can be determined using two approaches: 1) empiric prescribed activity of 131I (E-Rx); and 2) dosimetry-based prescribed activity of 131I (D-Rx). Aim: The aim of the study was to compare the relative treatment efficacy and side effects of D-Rx vs. E-Rx. Methods: A retrospective analysis was performed of patients with distant metastases and/or locoregionally advanced radioiodine-avid DTC who were treated with either D-Rx or E-Rx. Response to treatment was based on RECIST (Response Evaluation Criteria in Solid Tumors) 1.1 criteria. Results: The study group consisted of 87 patients followed for 51 ± 35 months, of whom 43 were treated with D-Rx and 44 with E-Rx. Multivariate analysis, controlling for age, gender, and status of metastases revealed that the D-Rx group tended to be 70% less likely to progress (odds ratio, 0.29; 95% confidence interval, 0.087–1.02; P = 0.052) and more likely to obtain complete response (CR) compared to the E-Rx group (odds ratio, 8.2; 95% confidence interval, 1.2–53.5; P = 0.029). There was an association in the D-Rx group between the observed CR and percentage of maximum tolerable activity given as a first treatment of 131I (P = 0.030). The advantage of D-Rx was specifically apparent in the locoregionally advanced group because CR was significantly higher in D-Rx vs. E-Rx in this group of patients (35.7 vs. 3.3%; P = 0.009). The rates of partial response, stable disease, and progression-free survival, as well as the frequency of side effects, were not significantly different between the two groups. Conclusion: Higher efficacy of D-Rx with a similar safety profile compared to E-Rx supports the rationale for employing individually prescribed activity in high-risk patients with DTC.

High-Risk Patients with Differentiated Thyroid Cancer T4 Primary Tumors Achieve Remnant Ablation Equally Well Using rhTSH or Thyroid Hormone Withdrawal

Thyroid ◽  
2014 ◽  
Vol 24 (3) ◽  
pp. 480-487 ◽  
Author(s):  
Peter Bartenstein ◽  
Elisa Caballero Calabuig ◽  
Carlo Ludovico Maini ◽  
Renzo Mazzarotto ◽  
M. Angustias Muros de Fuentes ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Hormone ◽  
High Risk ◽  
Differentiated Thyroid Cancer ◽  
Primary Tumors ◽  
Remnant Ablation ◽  
Thyroid Hormone Withdrawal ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Delayed risk stratification, to include the response to initial treatment (surgery and radioiodine ablation), has better outcome predictivity in differentiated thyroid cancer patients

2011 ◽  
Vol 165 (3) ◽  
pp. 441-446 ◽  
Author(s):  
Maria Grazia Castagna ◽  
Fabio Maino ◽  
Claudia Cipri ◽  
Valentina Belardini ◽  
Alexandra Theodoropoulou ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Risk Stratification ◽  
Initial Treatment ◽  
Differentiated Thyroid Cancer ◽  
Low Risk ◽  
Risk Category ◽  
Radioiodine Ablation ◽  
Risk Patients

IntroductionAfter initial treatment, differentiated thyroid cancer (DTC) patients are stratified as low and high risk based on clinical/pathological features. Recently, a risk stratification based on additional clinical data accumulated during follow-up has been proposed.ObjectiveTo evaluate the predictive value of delayed risk stratification (DRS) obtained at the time of the first diagnostic control (8–12 months after initial treatment).MethodsWe reviewed 512 patients with DTC whose risk assessment was initially defined according to the American (ATA) and European Thyroid Association (ETA) guidelines. At the time of the first control, 8–12 months after initial treatment, patients were re-stratified according to their clinical status: DRS.ResultsUsing DRS, about 50% of ATA/ETA intermediate/high-risk patients moved to DRS low-risk category, while about 10% of ATA/ETA low-risk patients moved to DRS high-risk category. The ability of the DRS to predict the final outcome was superior to that of ATA and ETA. Positive and negative predictive values for both ATA (39.2 and 90.6% respectively) and ETA (38.4 and 91.3% respectively) were significantly lower than that observed with the DRS (72.8 and 96.3% respectively,P<0.05). The observed variance in predicting final outcome was 25.4% for ATA, 19.1% for ETA, and 62.1% for DRS.ConclusionsDelaying the risk stratification of DTC patients at a time when the response to surgery and radioiodine ablation is evident allows to better define individual risk and to better modulate the subsequent follow-up.

scholarly journals OR21-07 The 2015 American Thyroid Association Risk Stratification System Is a Predictor of Persistent Disease in Real-World Clinical Practice

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Giorgio Grani ◽  
Marco Alfo’ ◽  
Valeria Ramundo ◽  
Efisio Puxeddu ◽  
Emanuela Arvat ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Risk Stratification ◽  
Real World ◽  
Initial Treatment ◽  
Response To Treatment ◽  
American Thyroid Association ◽  
Structural Disease ◽  
Stratification System ◽  
Risk Stratification System

Abstract Background. Management and follow-up of differentiated thyroid cancer (DTC) are guided by the likelihood of disease persistence or recurrence. The American Thyroid Association (ATA) practice guidelines provide a risk-estimation system based on data mainly derived by retrospective, single-center, and small cohorts. Aim. To validate the ATA risk-stratification system in predicting persistent structural disease. Methods. We analyzed data from the Italian Thyroid Cancer Observatory’s observational, web-based database, which prospectively enrolls newly diagnosed DTC patients in 40 Italian centers. For the present study we selected consecutive cases satisfying the inclusion criteria: 1) histological diagnosis of DTC, including papillary, follicular, and poorly differentiated tumors; 2) registration in the ITCO database between January 1, 2013 and April 23, 2019; 3) clinical evaluation between 6 and 18 month after primary treatment, including enough data to estimate the response to the initial treatment. Exclusion criteria were: histological diagnosis of NIFTP, medullary, or anaplastic thyroid cancer. The response to the initial treatment was categorized as excellent, biochemical incomplete, structural incomplete, or indeterminate based on imaging findings (neck ultrasound and other imaging studies, if performed), basal or stimulated serum thyroglobulin levels, and anti-Tg antibody levels. To model the response to treatment, we used a cumulative link model; given the hierarchical structure of the data, with patients nested within centers, we used a mixed-effect model, with a center-specific intercept summarizing unobserved center-specific characteristics. Results. Complete data about initial treatment and response to treatment after 6-18 months since initial treatment was available for 2071 patients. According to the ATA system, 1109 patients (53.6%) were classified as low-risk, 796 (38.4%) as intermediate, and 166 (8.0%) as high-risk. Excellent response was recorded in 1576 (76.1%) patients, indeterminate in 376 (18.2%), biochemical incomplete in 33 (1.6%), and structural incomplete in 86 (4.2%).The ATA risk stratification system is a significant predictor of response to treatment after 6-18 months: classification as intermediate- and high-risk increased the likelihood of a response worse than excellent (OR 1.68 [95% confidence intervals, CI 1.34-2.10] and 3.23 [95% CI 2.23-4.67], respectively), and a persistent structural disease (OR 4.67 [95% CI 2.59-8.43] and 16.48 [95% CI 7.87-34.5], respectively. In both analyses, the effect of the center (taking into account center-specific features) was negligible and not statistically significant. Conclusion. The 2015 ATA risk stratification system is a reliable predictor of short-term outcomes in patients with DTC, also if applied in a real-world setting consisting of several different clinical sites.

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