Giorgio Grani1, Maria Chiara Zatelli2, Marco Alfò3, Teresa Montesano4, Massimo Torlontano5, Silvia Morelli6, Maurilio Deandrea7, Alessandro Antonelli8, Cecilia Francese9, Graziano Ceresini10, Fabio Orlandi11, Carolina Adele Maniglia12, Rocco Bruno13, Salvatore Monti14, Maria Giulia Santaguida15, Andrea Repaci16, Giovanni Tallini16, Laura Fugazzola17, Fabio Monzani18, Raffaele Giubbini19, Ruth Rossetto20, Caterina Mian21, Anna Crescenzi22, Dario Tumino23, Loredana Pagano20,24, Luciano Pezzullo25, Celestino Pio Lombardi26, Emanuela Arvat27, Luisa Petrone28, Maria Grazia Castagna29, Giovanna Spiazzi30, Domenico Salvatore31, Domenico Meringolo32, Erica Solaroli33, Fabio Monari16, Flavia Magri34, Vincenzo Triggiani35, Roberto Castello36, Cesare Piazza37, Roberta Rossi38, Umberto Ferraro Petrillo3, Sebastiano Filetti1, Cosimo Durante1. 1. Department of Translational and Precision Medicine, Pathological and Oncological Sciences, Sapienza University of Rome, Rome, Italy. 2. Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy. 3. Department of Statistical Sciences, Pathological and Oncological Sciences, Sapienza University of Rome, Rome, Italy. 4. Department of Radiological, Pathological, Oncological Sciences, Sapienza University of Rome, Rome, Italy. 5. Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy. 6. Department of Medicine, University of Perugia, Perugia, Italy. 7. Division of Endocrinology, Diabetology, and Metabolism, Mauriziano Umberto I Hospital, Turin, Italy. 8. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 9. Division of Endocrinology, Clinica Salus di Battipaglia, Salerno, Italy. 10. Department of Medicine and Surgery, University of Parma, Parma, Italy. 11. Division of Endocrinology and Metabolism, Department of Oncology, Humanitas-Gradenigo Hospital, University of Turin, Turin, Italy. 12. Division of Endocrinology, Cervello Hospital, Palermo, Italy. 13. Unit of Endocrinology, Tinchi-Pisticci Hospital, Matera, Italy. 14. Department of Endocrinology, AOU Sant'Andrea, Sapienza Università di Roma, Rome, Italy. 15. Endocrine Unit, AUSL Latina, Latina, Italy. 16. Endocrinology, Pathology and Radiotherapy Units, University of Bologna Medical Center, S. Orsola-Malpighi Hospital, Bologna, Italy. 17. Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy. 18. Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 19. Nuclear Medicine Unit, Spedali Civili Università degli Studi di Brescia, Brescia, Italy. 20. Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy. 21. Endocrinology Unit, Department of Medicine-DIMED, University Hospital of Padua, Padua, Italy. 22. Pathology Unit, University Hospital Campus Bio-Medico, Rome, Italy. 23. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy. 24. Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy. 25. Struttura Complessa Chirurgia Oncologica della Tiroide, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy. 26. Division of Endocrine Surgery, Fondazione Policlinico Gemelli, Catholic University, Rome, Italy. 27. Oncological Endocrinology Unit, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy. 28. Endocrinology Unit, Careggi University Hospital, Florence, Italy. 29. Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy. 30. Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Verona, Verona, Italy. 31. Department of Public Health, University of Naples "Federico II," Naples, Italy. 32. Endocrinology Unit, Istituto Ramazzini, Bologna, Italy. 33. Endocrinology Unit, Medical Department, AUSL Bologna Maggiore-Bellaria Hospital, Bologna, Italy. 34. Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine, Istituti Clinici Scientifici Maugeri IRCCS, and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy. 35. Section of Internal Medicine, Geriatrics, Endocrinology and Rare Disease, Interdisciplinary Department of Medicine, School of Medicine, University of Bari, Bari, Italy. 36. Division of General Medicine, University Hospital of Verona, Verona, Italy. 37. Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy. 38. Endocrine Unit, Azienda Ospedaliero Universitaria S. Anna, Ferrara, Italy.
Abstract
Background: One of the most widely used risk stratification systems for estimating individual patients' risk of persistent or recurrent differentiated thyroid cancer (DTC) is the American Thyroid Association (ATA) guidelines. The 2015 ATA version, which has increased the number of patients considered at low or intermediate risk, has been validated in several retrospective, single-center studies. The aims of this study were to evaluate the real-world performance of the 2015 ATA risk stratification system in predicting the response to treatment 12 months after the initial treatment and to determine the extent to which this performance is affected by the treatment center in which it is used. Methods: A prospective cohort of DTC patients collected by the Italian Thyroid Cancer Observatory web-based database was analyzed. We reviewed all records present in the database and selected consecutive cases that satisfied inclusion criteria: (i) histological diagnosis of DTC, with the exclusion of noninvasive follicular thyroid neoplasm with papillary-like nuclear features; (ii) complete data of the initial treatment and pathological features; and (iii) results of 1-year follow-up visit (6-18 months after the initial treatment), including all data needed to classify the estimated response to treatment. Results: The final cohort was composed of 2071 patients from 40 centers. The ATA risk of persistent/recurrent disease was classified as low in 1109 patients (53.6%), intermediate in 796 (38.4%), and high in 166 (8.0%). Structural incomplete responses were documented in only 86 (4.2%) patients: 1.5% in the low-risk, 5.7% in the intermediate-risk, and 14.5% in the high-risk group. The baseline ATA risk class proved to be a significant predictor of structural persistent disease, both for intermediate-risk (odds ratio [OR] 4.67; 95% confidence interval [CI] 2.59-8.43) and high-risk groups (OR 16.48; CI 7.87-34.5). Individual center did not significantly influence the prediction of the 1-year disease status. Conclusions: The ATA risk stratification system is a reliable predictor of short-term outcomes in patients with DTC in real-world clinical settings characterized by center heterogeneity in terms of size, location, level of care, local management strategies, and resource availability.
Background: One of the most widely used risk stratification systems for estimating individual patients' risk of persistent or recurrent differentiated thyroid cancer (DTC) is the American Thyroid Association (ATA) guidelines. The 2015 ATA version, which has increased the number of patients considered at low or intermediate risk, has been validated in several retrospective, single-center studies. The aims of this study were to evaluate the real-world performance of the 2015 ATA risk stratification system in predicting the response to treatment 12 months after the initial treatment and to determine the extent to which this performance is affected by the treatment center in which it is used. Methods: A prospective cohort of DTC patients collected by the Italian Thyroid Cancer Observatory web-based database was analyzed. We reviewed all records present in the database and selected consecutive cases that satisfied inclusion criteria: (i) histological diagnosis of DTC, with the exclusion of noninvasive follicular thyroid neoplasm with papillary-like nuclear features; (ii) complete data of the initial treatment and pathological features; and (iii) results of 1-year follow-up visit (6-18 months after the initial treatment), including all data needed to classify the estimated response to treatment. Results: The final cohort was composed of 2071 patients from 40 centers. The ATA risk of persistent/recurrent disease was classified as low in 1109 patients (53.6%), intermediate in 796 (38.4%), and high in 166 (8.0%). Structural incomplete responses were documented in only 86 (4.2%) patients: 1.5% in the low-risk, 5.7% in the intermediate-risk, and 14.5% in the high-risk group. The baseline ATA risk class proved to be a significant predictor of structural persistent disease, both for intermediate-risk (odds ratio [OR] 4.67; 95% confidence interval [CI] 2.59-8.43) and high-risk groups (OR 16.48; CI 7.87-34.5). Individual center did not significantly influence the prediction of the 1-year disease status. Conclusions: The ATA risk stratification system is a reliable predictor of short-term outcomes in patients with DTC in real-world clinical settings characterized by center heterogeneity in terms of size, location, level of care, local management strategies, and resource availability.
Authors: Ayanthi Wijewardene; Matti Gild; Carolina Nylén; Geoffrey Schembri; Paul Roach; Jeremy Hoang; Ahmad Aniss; Anthony Glover; Mark Sywak; Stan Sidhu; Diana Learoyd; Bruce Robinson; Lyndal Tacon; Roderick Clifton-Bligh Journal: Eur Thyroid J Date: 2021-05-25
Authors: Friederike Eilsberger; R Michael Tuttle; Damiano Librizzi; Andreas Pfestroff; Markus Luster; Frederik A Verburg Journal: Endocrine Date: 2020-11-01 Impact factor: 3.633
Authors: Ilaria Celletti; Daniele Fresilli; Corrado De Vito; Marco Bononi; Sara Cardaccio; Alessia Cozzolino; Cosimo Durante; Giorgio Grani; Gianmarco Grimaldi; Andrea M Isidori; Carlo Catalano; Vito Cantisani Journal: Radiol Med Date: 2021-06-15 Impact factor: 3.469