Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, Viale Benedetto XV, 6, 16132, Genoa, Italy.
Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
J Endocrinol Invest. 2023 Oct;46(10):2157-2164. doi: 10.1007/s40618-023-02070-y. Epub 2023 Mar 28.
In the last edition of the American Joint Committee on Cancer (AJCC) staging system, differentiated thyroid cancers (DTC) showing microscopic extrathyroidal extension (mETE) are considered comparable to intrathyroidal cancers for their clinical behavior and prognosis. The aim of the study is to evaluate the impact of this updated assessment of T, when applied to the postoperative recurrence risk stratification, according to the American Thyroid Association Guidelines (ATA-RR).
One-hundred DTC patients who underwent total thyroidectomy were retrospectively evaluated. The downstaging of mETE was introduced in the definition of T, and the updated classification defined as modified ATA-RR (ATAm-RR). For each patient, post-surgical basal and stimulated thyroglobulin (Tg) levels, neck ultrasound (US) and post-ablative 131-I whole body scan (WBS) reports were considered. The predictive performance (PP) of disease recurrence was calculated both for each single parameter, as well as for all of them.
According to ATAm-RR classification, 19/100 patients (19%) were downstaged. ATA-RR proved a significant PP for disease recurrence (DR) (sensitivity 75.0%, specificity 63.0%, p = 0.023). However, ATAm-RR performed slightly better due to an increased specificity (sensitivity 75.0%, specificity 83.7%, p < 0.001). For both classifications, the PP was optimal when all the above-mentioned predictive parameters were considered.
Our results suggest that the new assessment of T considering mETE resulted in a downgrading of ATA-RR class in a significant number of patients. This provides a better PP for disease recurrence, and the best PP was obtained when considering the whole predictive variables together.
在 AJCC 分期系统的上一版中，显示有镜下甲状腺外延伸（mETE）的分化型甲状腺癌（DTC）在临床行为和预后方面与甲状腺内癌相似。本研究旨在评估根据 ATA 指南（ATA-RR），将 T 的这一最新评估应用于术后复发风险分层时的影响。
回顾性评估了 100 例行甲状腺全切除术的 DTC 患者。在 T 的定义中引入了 mETE 的降级，并用定义为改良 ATA-RR（ATAm-RR）的更新分类进行定义。对于每个患者，考虑了术后基础和刺激甲状腺球蛋白（Tg）水平、颈部超声（US）和消融后 131I 全身扫描（WBS）报告。计算了每种单一参数以及所有参数对疾病复发的预测性能（PP）。
根据 ATA m-RR 分类，19/100 例患者（19%）降级。ATA-RR 对疾病复发（DR）具有显著的 PP（敏感性 75.0%，特异性 63.0%，p=0.023）。然而，由于特异性提高，ATAm-RR 略好（敏感性 75.0%，特异性 83.7%，p<0.001）。对于这两种分类，当考虑所有上述预测参数时，PP 最佳。
我们的结果表明，考虑到 mETE，对 T 的新评估导致相当数量的患者从 ATA-RR 类别降级。这为疾病复发提供了更好的 PP，当同时考虑所有预测变量时，获得了最佳的 PP。
