Dynamic Risk Stratification in Stage I Papillary Thyroid Cancer Patients Younger Than 45 Years of Age

作者：Sung Tae Yon; Cho Jae Won; Lee Yu mi; Lee Yi Ho; Kwon Hyemi; Jeon Min Ji; Kim Won Gu; Choi Young Jun; Song Dong Eun; Chung Ki Wook; Yoon Jong Ho^*; Hong Suck Joon

来源：Thyroid, 2017, 27(11): 1400-1407.

DOI：10.1089/thy.2017.0199

• stage I
• classical papillary thyroid cancer
• dynamic risk stratification
• 45 years
• recurrence

Background: This study validated the dynamic risk stratification (DRS) system with regard to its association with structural recurrence and risk factors associated with non-excellent responses in patients <45 years with stage I classical papillary thyroid cancer (PTC).
Methods: This historical cohort study included 598 patients with stage I classical PTC <45 years of age treated with total thyroidectomy followed by radioactive iodine remnant ablation (n = 440), total thyroidectomy without radioactive iodine remnant ablation (n = 23), and thyroid lobectomy alone (n = 135).
Results: The median follow-up period was 123 months. Structural recurrence occurred in 4.2% (n = 18/432) of the patients with an excellent response, 17.1% (18/105) of patients with an indeterminate response, 44.7% (17/38) of patients with a biochemically incomplete response, and 82.6% (19/23) of patients with a structurally incomplete response (p < 0.001) during the follow-up. The disease-free survival curves of each response showed significant differences (p < 0.001). Extensive extrathyroidal extension and extranodal extension were the independent risk factors associated with non-excellent response (p < 0.05).
Conclusions: DRS may reduce unnecessary additional treatments by reclassifying initial risk estimates of structural recurrence. Furthermore, applying the risk factors associated with non-excellent response to initial therapy may be a more useful and viable surrogate of the risk for structural recurrence in stage I PTC patients <45 years of age.

• 出版日期2017-11