Kowalska Aldona, Walczyk Agnieszka, Pałyga Iwona, Gąsior-Perczak Danuta, Gadawska-Juszczyk Klaudia, Szymonek Monika, Trybek Tomasz, Lizis-Kolus Katarzyna, Szyska-Skrobot Dorota, Mikina Estera, Hurej Stefan, Słuszniak Janusz, Mężyk Ryszard, Góźdź Stanisław
Departments of Endocrinology, Holycross Cancer Centre, Kielce, Poland.
Department of Surgical Oncology, Holycross Cancer Centre, Kielce, Poland.
PLoS One. 2016 Apr 14;11(4):e0153242. doi: 10.1371/journal.pone.0153242. eCollection 2016.
There has been a marked increase in the detection of differentiated thyroid carcinoma (DTC) over the past few years, which has improved the prognosis. However, it is necessary to adjust treatment and monitoring strategies relative to the risk of an unfavourable disease course.
This retrospective study examined data from 916 patients with DTC who received treatment at a single centre between 2000 and 2013. The utility of the American Thyroid Association (ATA) and the European Thyroid Association (ETA) recommended systems for early assessment of the risk of recurrent/persistent disease was compared with that of the recently recommended delayed risk stratification (DRS) system.
The PPV and NPV for the ATA (24.59% and 95.42%, respectively) and ETA (24.28% and 95.68%, respectively) were significantly lower than those for the DRS (56.76% and 98.5%, respectively) (p<0.0001). The proportion of variance for predicting the final outcome was 15.8% for ATA, 16.1% for ETA and 56.7% for the DRS. Recurrent disease was rare (1% of patients), and was nearly always identified in patients at intermediate/high risk according to the initial stratification (9/10 cases).
The DRS showed a better correlation with the risk of persistent disease than the early stratification systems and allows personalisation of follow-up. If clinicians plan to alter the intensity of surveillance, patients at intermediate/high risk according to the early stratification systems should remain within the specialized centers; however, low risk patients can be referred to endocrinologists or other appropriate practitioners for long-term follow-up, as these patients remained at low risk after risk re-stratification.
在过去几年中，分化型甲状腺癌（DTC）的检出率显著增加，这改善了预后。然而，有必要根据疾病进展不利风险调整治疗和监测策略。
这项回顾性研究分析了2000年至2013年间在单一中心接受治疗的916例DTC患者的数据。将美国甲状腺协会（ATA）和欧洲甲状腺协会（ETA）推荐的用于早期评估复发/持续性疾病风险的系统与最近推荐的延迟风险分层（DRS）系统的效用进行了比较。
ATA（分别为24.59%和95.42%）和ETA（分别为24.28%和95.68%）的阳性预测值（PPV）和阴性预测值（NPV）显著低于DRS（分别为56.76%和98.5%）（p<0.0001）。预测最终结果的方差比例，ATA为15.8%，ETA为16.1%，DRS为56.7%。复发性疾病很少见（占患者的1%），几乎总是在根据初始分层处于中/高风险的患者中发现（10例中有9例）。
与早期分层系统相比，DRS与持续性疾病风险的相关性更好，并允许进行个性化随访。如果临床医生计划改变监测强度，根据早期分层系统处于中/高风险的患者应留在专科中心；然而，低风险患者可转诊至内分泌科医生或其他合适的医生进行长期随访，因为这些患者在重新分层后仍处于低风险。
