Departments of Internal Medicine.
Eur J Endocrinol. 2013 Nov 22;170(1):23-30. doi: 10.1530/EJE-13-0524. Print 2014 Jan.
A 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 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).
The 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%.
Our 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.
提出了一种新的风险分层系统，用于使用初始治疗的反应来估计分化型甲状腺癌（DTC）患者的复发风险。在这里，我们描述了修改后的动态风险分层系统，该系统考虑了血清抗甲状腺球蛋白抗体（TgAb）的状态，并验证了该系统用于评估 DTC 患者复发的风险。
纳入了 2000 年至 2005 年间因 DTC 接受全甲状腺切除术和放射性碘残余消融的患者。我们根据初始治疗的反应将患者分为四组（“极好”、“可接受”、“生化不完全”和“结构不完全”反应）。
715 例 DTC 患者的中位随访期为 8 年。初始治疗的反应是复发性/持续性 DTC 的重要风险预测因子。与“极好反应”组相比，“可接受反应”组、“生化不完全反应”组和“结构不完全反应”组的复发相对风险（95%CI）分别为 16.5（6.3-43.0）、41.3（15.4-110.8）和 281.2（112.9-700.5）（P<0.001，P<0.001，P<0.001）。初始治疗“极好反应”组的无疾病生存率为 98.3%，而“结构不完全反应”组仅为 6.8%。
我们的研究验证了包括血清 TgAb 状态在内的改良动态风险分层系统预测 DTC 患者复发性/持续性疾病的有效性。使用初始治疗的反应进行个体化风险评估可能有助于 DTC 患者的随访和管理。
