Nuclear Medicine and Endocrine Oncology DepartmentM. Sklodowska-Curie Memorial Institute - Cancer Center, Gliwice, Poland.
Tumor Pathology DepartmentM. Sklodowska-Curie Memorial Institute - Cancer Center, Gliwice, Poland.
Endocr Relat Cancer. 2017 Nov;24(11):R387-R402. doi: 10.1530/ERC-17-0270. Epub 2017 Aug 18.
The adequate risk stratification in thyroid carcinoma is crucial to avoid on one hand the overtreatment of low-risk and on the other hand the undertreatment of high-risk patients. The question how to properly assess the risk of relapse has been discussed during recent years and resulted in a substantial change in our approach to risk stratification in differentiated thyroid cancer, proposed by the newest ATA guidelines. First initial risk stratification, based on histopathological data is carried out just after primary surgery. It should be emphasized, that a high quality of histopathological report is crucial for proper risk stratification. Next, during the follow-up, patients are restratified considering their response to treatment applied and classified to one of the following categories: excellent response, biochemical incomplete response, structural incomplete or indeterminate response. This new approach is called dynamic risk stratification as, in contrary to the previous rigid evaluation performed at diagnosis, reflects a real-time prognosis and thereby substantially influences and personalizes disease management. In this review, we raise some unresolved questions, among them the lack of prospective studies, fulfilling evidence-based criteria, necessary to validate this model of risk stratification. We also provided some data concerning the use of dynamic risk stratification in medullary thyroid cancer, not yet reflected in ATA guidelines. In conclusion, dynamic risk stratification allows for better prediction of the risk of recurrence in thyroid carcinoma, what has been demonstrated in numerous retrospective analyses. However, the validation of this approach in prospective studies seems to be our task for near future.
甲状腺癌的充分风险分层对于避免一方面对低危患者过度治疗，另一方面对高危患者治疗不足至关重要。近年来，人们一直在讨论如何正确评估复发风险，这导致我们对分化型甲状腺癌的风险分层方法发生了重大变化，ATA 最新指南对此进行了建议。首先，在初次手术后，根据组织病理学数据进行初步风险分层。应该强调的是，高质量的组织病理学报告对于正确的风险分层至关重要。其次，在随访期间，根据治疗反应对患者进行再次分层，并将其分为以下几类之一：极好反应、生化不完全缓解、结构不完全或不确定反应。这种新方法称为动态风险分层，因为与之前在诊断时进行的僵硬评估相反，它反映了实时预后，从而极大地影响并个性化了疾病管理。在这篇综述中，我们提出了一些尚未解决的问题，其中包括缺乏满足循证标准的前瞻性研究，这些研究对于验证这种风险分层模型是必要的。我们还提供了一些关于在甲状腺髓样癌中使用动态风险分层的相关数据，这些数据尚未反映在 ATA 指南中。总之，动态风险分层可以更好地预测甲状腺癌的复发风险，这已在许多回顾性分析中得到证实。然而，在前瞻性研究中验证这种方法似乎是我们未来的任务。
