Optimal Timing of Initiating Dynamic Risk Stratification During the Early Postoperative Period in Patients with Differentiated Thyroid Carcinoma After Thyroidectomy and Radioactive Iodine Remnant Ablation

Background This study investigated the optimal timing to initiate assessment of the response to initial therapy during the early postoperative period in patients with differentiated thyroid carcinoma (DTC) using dynamic risk stratification (DRS). Methods This historical cohort study included 510 pat...

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Bibliographic Details
Published in:Annals of surgical oncology 2021-10, Vol.28 (11), p.6580-6589
Main Authors: Park, Jae Hyun, Moon, Gil Seong, Nam, Kyung Tae, Yoon, Jong Ho
Format: Article
Language:English
Subjects:
Ablation
Endocrine Tumors
Iodine
Medicine
Medicine & Public Health
Metastases
Oncology
Patients
Postoperative period
Regression analysis
Surgery
Surgical Oncology
Thyroid cancer
Thyroid carcinoma
Thyroidectomy
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Summary:Background This study investigated the optimal timing to initiate assessment of the response to initial therapy during the early postoperative period in patients with differentiated thyroid carcinoma (DTC) using dynamic risk stratification (DRS). Methods This historical cohort study included 510 patients with DTC who underwent a total thyroidectomy followed by radioactive iodine (RAI) remnant ablation. DRS for these patients was categorized into subgroups according to the time into the follow-up period at which the response to initial therapy was assessed. The ability of each DRS subgroup to predict the long-term structural recurrence of cancer was compared using the proportion of variance explained (PVE) from logistic regression models. Results The median follow-up period was 108 months. Structural recurrence occurred in 7.6% of patients ( n  = 39/510). The PVE for long-term structural recurrence was higher among DRS subgroups (28.8–34.19%) compared with the American Joint Committee on Cancer/Union for International Cancer Control tumor-node-metastasis staging system (both the 7th and 8th editions; 4.01% and 6.13%, respectively) and the American Thyroid Association initial risk estimate (4.59%). Among the DRS subgroups, DRS assessed between 2 and 3 years after the initial surgery was associated with the highest PVE (34.19%). Conclusions The first assessment of DRS optimally predicts long-term structural recurrence in patients with DTC who underwent a total thyroidectomy and subsequent RAI remnant ablation at that 2- to 3-year postoperative period.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-021-09721-5