August 19, 2019
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ATA risk assessment effectively predicts thyroid cancer persistence

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Thyroid cancer persistence is accurately captured by the American Thyroid Association’s 2015 risk stratification system for patients with more severe forms of the condition, according to findings published in Thyroid.

Evert F.S. van Velsen

“Our findings contribute to the knowledge about the clinical value of the 2015 ATA risk stratification system, especially regarding risk of recurrence in high-risk patients, and thereby provides a direction for use in daily clinical practice,” Evert F.S. van Velsen, MD, MSc, a PhD student and internist in training at the Academic Center for Thyroid Diseases in the department of internal medicine at Erasmus Medical Center in Rotterdam, the Netherlands, told Endocrine Today.

Van Velsen and colleagues identified 236 adults with high-risk thyroid cancer diagnosed between 2002 and 2015 based on the ATA risk stratification system. Every patient in the cohort received a total thyroidectomy or a hemithyroidectomy, according to the researchers, who examined medical records to assess outcomes for the study population until December 2017.

Based on imaging, 51% of the population still had structural disease after 6 to 18 months, which was when the researchers assessed initial therapy outcomes. At this time point, 26% of the population had unstimulated or stimulated thyroglobulin levels of less than 1 ng/mL or less than 10 ng/mL, respectively, which equated to an indeterminate response, whereas 17% did not exhibit any signs of the condition, which meant an excellent response. The remaining 7% of patients presented clean imaging readings but in combination with at least 1 ng/mL of suppressed thyroglobulin level, at least 10 ng/mL of stimulated postoperative serum thyroglobulin level and/or “rising anti-thyroglobulin levels,” according to the researchers, who defined this as a biochemically incomplete response. In addition, they wrote that during this phase of follow-up, there was an association between the results patients presented after therapy and both overall survival (P < .001) and disease-specific survival (P < .001). At a median of 22 months, 35% of the total population had no evidence of thyroid cancer, but at 47 months, the disease returned for 14% of these patients, according to the researchers.

Thyroid male 2019. 
Thyroid cancer persistence is accurately captured by the American Thyroid Association’s 2015 risk stratification system for patients with more severe forms of the condition.
Source: Adobe Stock

Structural disease remained in the same percentage of the population (51%) at the conclusion of the study, including 74% of those who met the criteria for this response at the first assessment.

“The presence of distant metastases or an elevated postoperative [thyroglobulin level] increased the risk of having persistent disease,” the researchers wrote.

An excellent response was noted in 29% of the population, including 10% of those who had structural disease at the first assessment, the researchers wrote. In addition, 16% displayed an indeterminate response and 4% met the criteria for a biochemically incomplete response.

“We found a relative high recurrence risk (14%) in these ATA high-risk patients, which illustrates the importance of careful follow-up in these initial high-risk patients, even after an excellent response to therapy,” van Velsen said. “Clinicians should be aware of this substantial high recurrence risk when treating and following up on these high-risk patients.” – by Phil Neuffer

For more information:

Evert F.S. van Velsen, MD, MSc, can be reached at e.vanvelsen@erasmusmc.nl.

Disclosures: The authors report no relevant financial disclosures.