Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Thyroid. 2023 Jun;33(6):705-714. doi: 10.1089/thy.2023.0060. Epub 2023 Apr 28.
Molecular testing (MT) is emerging as a potential prognostic factor that can be available before treatment of differentiated thyroid carcinoma begins. Among patients eligible for either lobectomy or total thyroidectomy as their initial therapy, our study aims were to assess (1) if conventionally available preoperative factors are associated with incomplete response to initial therapy, and (2) if MT results can be a surrogate for the ATA Risk Stratification System (RSS) to estimate risk of recurrence. The data of consecutive thyroid cancer patients without preoperative lateral neck disease or distant metastasis who underwent index thyroidectomy between November 1, 2017 and October 31, 2021 were reviewed. Logistic regression models including preoperative variables such as MT and/or the postoperatively available RSS were constructed to predict disease recurrence, either structural or biochemical. Model discrimination using the c-statistic and goodness-of-fit test were compared. Among 945 patients studied, 50 (5.2%) recurred with 18-month median follow-up. Recurrences were detected in 17 (2.9%), 20 (6.7%), and 13 (22.8%) patients with RSS-low, -intermediate, and -high cancers, respectively ( < 0.001). In multivariable analysis, only tumor size was associated with recurrence (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.1-1.5). In a different model analyzing 440 (46.6%) patients with available MT results, recurrence was associated with both larger tumor size (OR 1.4 [95% CI 1.1-1.8]) and MT results ( < 0.001). Including MT improved the c-statistic by 27%, which was statistically no different than the model incorporating only the RSS ( = 0.15). Disease recurrence was observed across all ATA RSS categories in short-term follow-up, and tumor size was the only conventional preoperative factor associated with recurrence. When MT results were incorporated, they not only improved predictive ability beyond tumor size alone, but also yielded similar ability as the gold standard ATA RSS. Thus, MT results might aid the development of novel preoperative risk stratification algorithms.
分子检测（MT）作为一种潜在的预后因素正在出现，它可以在开始治疗分化型甲状腺癌之前获得。在适合接受腺叶切除术或甲状腺全切除术作为初始治疗的患者中，我们的研究目的是评估：（1）传统的术前因素是否与初始治疗的不完全反应有关，以及（2）MT 结果是否可以作为 ATA 风险分层系统（RSS）的替代指标来估计复发风险。我们回顾了 2017 年 11 月 1 日至 2021 年 10 月 31 日期间接受指数甲状腺切除术的无术前侧颈部疾病或远处转移的连续甲状腺癌患者的数据。构建了包括术前 MT 和/或术后可获得的 RSS 等变量的逻辑回归模型，以预测结构性或生化性疾病复发。使用 C 统计量和拟合优度检验比较模型的判别能力。在研究的 945 例患者中，有 50 例（5.2%）在 18 个月的中位随访期间复发。在 RSS 低、中、高癌症患者中分别检测到 17 例（2.9%）、20 例（6.7%）和 13 例（22.8%）的复发（ < 0.001）。多变量分析显示，只有肿瘤大小与复发相关（优势比 [OR] 1.3，95%置信区间 [CI] 1.1-1.5）。在另一个分析 440 例（46.6%）可获得 MT 结果的患者的模型中，较大的肿瘤大小（OR 1.4 [95% CI 1.1-1.8]）和 MT 结果与复发相关（ < 0.001）。纳入 MT 将 C 统计量提高了 27%，与仅包含 RSS 的模型统计学上无差异（ = 0.15）。在短期随访中，所有 ATA RSS 类别中均观察到疾病复发，肿瘤大小是唯一与复发相关的传统术前因素。当纳入 MT 结果时，它们不仅改善了仅肿瘤大小的预测能力，而且与金标准 ATA RSS 具有相似的能力。因此，MT 结果可能有助于开发新的术前风险分层算法。
