Choudhury Sayak, Agrawal Archi, Pantvaidya Gouri, Shah Sneha, Purandare Nilendu, Puranik Ameya, Rangarajan Venkatesh
Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhaba National Institute (HBNI), E. Borges Road, Parel, Mumbai, 400 012, India.
Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhaba National Institute (HBNI), E. Borges Road, Parel, Mumbai, 400 012, India.
Eur J Nucl Med Mol Imaging. 2020 Mar;47(3):547-553. doi: 10.1007/s00259-019-04582-3. Epub 2019 Nov 9.
The 2015 American Thyroid Association (ATA) guideline have suggested modifications in the risk stratification (RS) for differentiated thyroid cancer (DTC) patients, introduced the concept of dynamic risk stratification (DRS) and redefined the role of radioactive iodine (RAI) in treatment algorithm. The aim of this retrospective audit was to assess the practical implications of these modifications in management of DTC.
A total of 138 DTC patients were stratified according to ATA 2009 and 2015 guidelines into low (LR), intermediate (IR) and high (HR) risk groups. Change in RS and in intention of RAI use was calculated. Deviation in administered RAI dosage from the guidelines was assessed. 1-year follow-up data was audited to assess how the DRS modified the initial risk estimate.
A total of 11.6% of patients changed their RS categories in 2015 guidelines. A total of 10.1% got upstaged to HR, and 1.4% got downstaged to LR. In 2.17% of patients' intention of RAI use changed to remnant ablation from adjuvant therapy and 65% of the LR patients won't require any RAI therapy. A total of 26.7% of patients had received significantly more RAI dosage according to ATA 2015. At 1-year follow-up according to DRS 84% of LR, 75% of IR and 44% of HR patients showed excellent response (ER).
More patients changed RS to HR than to LR. Intention of RAI use changed in only a small number of patients. Significantly higher dosage of RAI is being administered to patients in current practice. The effect of DRS in modifying the initial RS was most prominent in IR, with most showing ER to initial therapy.
2015年美国甲状腺协会（ATA）指南建议对分化型甲状腺癌（DTC）患者的风险分层（RS）进行修改，引入动态风险分层（DRS）概念并重新定义放射性碘（RAI）在治疗方案中的作用。这项回顾性审计的目的是评估这些修改对DTC管理的实际影响。
根据ATA 2009年和2015年指南，将138例DTC患者分为低风险（LR）、中风险（IR）和高风险（HR）组。计算RS变化及RAI使用意向的变化。评估给予的RAI剂量与指南的偏差。审核1年随访数据以评估DRS如何修改初始风险估计。
在2015年指南中，共有11.6%的患者改变了RS类别。共有10.1%的患者上调至高风险，1.4%的患者下调至低风险。2.17%的患者RAI使用意向从辅助治疗改为残留消融，65%的LR患者不需要任何RAI治疗。根据ATA 2015，共有26.7%的患者接受的RAI剂量明显更多。根据DRS进行1年随访时，84%的LR患者、75%的IR患者和44%的HR患者显示出良好反应（ER）。
从RS转为高风险的患者多于转为低风险的患者。只有少数患者改变了RAI使用意向。目前临床实践中给予患者的RAI剂量明显更高。DRS对初始RS的修改作用在中风险组最为突出，大多数患者对初始治疗显示出良好反应。
