Ceruti Daniele, Ottevanger Petronella B, De Leo Simone, Bonenkamp Han J, Colombo Carla, Gotthardt Martin, Fugazzola Laura, Netea-Maier Romana T
Eur Thyroid J. 2025 Aug 8;14(4). doi: 10.1530/ETJ-25-0161.
To evaluate differences in the presentation, diagnostic/therapeutic approaches, and outcome of differentiated thyroid cancer (DTC) in an Italian and a Dutch referral centre.
We retrospectively included 919 patients (586 Italian, 333 Dutch), and compared the two cohorts as a whole and according to ATA risk classes. Dynamic risk stratification (DRS) and Kaplan-Meier curves were used to compare progression-free survival (PFS) and disease-specific survival (DSS).
Several differences (P < 0.001) were found in clinicopathological features and in diagnostic/therapeutic modalities. The Dutch cohort had a higher age at diagnosis, a higher number of patients presenting with metastatic disease, and patients with stage III/IV. Most Italian patients showed a low/intermediate ATA risk, while high-risk patients represented half of the Dutch cohort. The Dutch cohort received a more intensive first treatment and more additional treatments during follow-up (i.e. surgery, radiotherapy, and systemic treatments). DRS analysis showed comparable excellent and biochemical incomplete responses, while the Dutch cohort had a lower rate of indeterminate and a higher rate of structural incomplete responses (P < 0.001). The Dutch cohort had a significantly worse 5-year PFS, and TC-related mortality was 10 and 1% for the Dutch and Italian cohorts, respectively, in line with the higher rate of advanced disease at presentation, with DSS still excellent for both.
Data reported in the present comparison between two European countries highlight a different prevalence, presentation, and outcome of DTC, likely due to variabilities in healthcare systems, iodine nutritional status, and diagnostic and treatment approaches.
评估意大利和荷兰两家转诊中心分化型甲状腺癌（DTC）在临床表现、诊断/治疗方法及预后方面的差异。
我们回顾性纳入了919例患者（586例意大利患者，333例荷兰患者），并对两个队列进行了整体比较以及根据美国甲状腺协会（ATA）风险分层进行比较。采用动态风险分层（DRS）和Kaplan-Meier曲线来比较无进展生存期（PFS）和疾病特异性生存期（DSS）。
在临床病理特征以及诊断/治疗方式方面发现了若干差异（P < 0.001）。荷兰队列的诊断年龄更高，出现转移性疾病的患者数量更多，且III/IV期患者更多。大多数意大利患者表现为低/中度ATA风险，而高危患者占荷兰队列的一半。荷兰队列在首次治疗时接受了更强化的治疗，且在随访期间接受了更多的额外治疗（即手术、放疗和全身治疗）。DRS分析显示，优秀和生化不完全缓解情况相当，但荷兰队列的不确定率较低，结构不完全缓解率较高（P < 0.001）。荷兰队列的5年PFS明显更差，荷兰和意大利队列的甲状腺癌相关死亡率分别为10%和1%，这与就诊时晚期疾病发生率较高一致，两个队列的DSS仍然都很优秀。
本次两个欧洲国家之间比较所报告的数据凸显了DTC在患病率、临床表现和预后方面的差异，这可能是由于医疗保健系统、碘营养状况以及诊断和治疗方法的差异所致。
