Application of the American Thyroid Association Risk Assessment in Patients with Differentiated Thyroid Carcinoma in a German Population
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Data Extraction
2.3. Analysis
3. Results
3.1. Risk Classification into the Different ATA Groups
3.2. Patients Age as a Factor Concerning Response in Papillary Thyroid Carcinoma
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Haugen, B.R.; Alexander, E.K.; Bible, K.C.; Doherty, G.M.; Mandel, S.J.; Nikiforov, Y.E.; Pacini, F.; Randolph, G.W.; Sawka, A.M.; Schlumberger, M.; et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016, 26, 1–133. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Pacini, F.; Fuhrer, D.; Elisei, R.; Handkiewicz-Junak, D.; Leboulleux, S.; Luster, M.; Schlumberger, M.; Smit, J.W. 2022 ETA Consensus Statement: What are the indications for post-surgical radioiodine therapy in differentiated thyroid cancer? Eur. Thyroid J. 2022, 11, e210046. [Google Scholar] [CrossRef]
- Ittermann, T.; Albrecht, D.; Arohonka, P.; Bilek, R.; de Castro, J.J.; Dahl, L.; Filipsson Nystrom, H.; Gaberscek, S.; Garcia-Fuentes, E.; Gheorghiu, M.L.; et al. Standardized Map of Iodine Status in Europe. Thyroid 2020, 30, 1346–1354, Erratum in Thyroid 2022, 32, 603. [Google Scholar] [CrossRef]
- Völzke, H.; Lüdemann, J.; Robinson, D.M.; Spieker, K.W.; Schwahn, C.; Kramer, A.; John, U.; Meng, W. The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area. Thyroid 2003, 13, 803–810. [Google Scholar] [CrossRef] [Green Version]
- Maneck, M.; Dotzenrath, C.; Dralle, H.; Fahlenbrach, C.; Steinmüller, T.; Simon, D.; Tusch, E.; Jeschke, E.; Günster, C. Fallzahlen und Komplikationen nach Schilddrüsenoperationen in Deutschland: Eine Analyse der Routinedaten von 48387 AOK-Patienten. Chirurg 2021, 92, 40–48. [Google Scholar] [CrossRef]
- Eilsberger, F.; Tuttle, R.M.; Librizzi, D.; Pfestroff, A.; Luster, M.; Verburg, F.A. Perioperative diagnostics of patients referred for radioiodine therapy of differentiated thyroid carcinoma: Referral center experience in an iodine-insufficient country. Endocrine 2021, 72, 721–726. [Google Scholar] [CrossRef]
- Seifert, P.; Freesmeyer, M. Preoperative diagnostics in differentiated thyroid carcinoma. Nuklearmedizin 2017, 56, 201–210. (In English) [Google Scholar] [CrossRef] [PubMed]
- Shah, S.; Boucai, L. Effect of Age on Response to Therapy and Mortality in Patients With Thyroid Cancer at High Risk of Recurrence. J. Clin. Endocrinol. Metab. 2017, 103, 689–697. [Google Scholar] [CrossRef]
- Alzahrani, A.S.; Moria, Y.; Mukhtar, N.; Aljamei, H.; Mazi, S.; Albalawi, L.; Aljomaiah, A. Course and Predictive Factors of Incomplete Response to Therapy in Low- and Intermediate-Risk Thyroid Cancer. J. Endocr. Soc. 2020, 5, bvaa178. [Google Scholar] [CrossRef] [PubMed]
- Tuttle, R.M.; Haugen, B.; Perrier, N.D. Updated American Joint Commitee on Cancer/Tumor-Node-Metastasis Staging System for Differentiated and Anaplastic Thyroid Cancer (Eighth Edition): What Changed and Why? Thyroid 2017, 27, 751–756. [Google Scholar] [CrossRef]
- Tuttle, R.M.; Tala, H.; Shah, J.; Leboeuf, R.; Ghossein, R.; Gonen, M.; Brokhin, M.; Omry, G.; Fagin, J.A.; Shaha, A. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: Using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid 2010, 20, 1341–1349. [Google Scholar]
- Vaisman, F.; Momesso, D.; Bulzico, D.A.; Pessoa, C.H.; Dias, F.; Corbo, R.; Vaisman, M.; Tuttle, R.M. Spontaneous remission in thyroid cancer patients after biochemical incomplete response to initial therapy. Clin. Endocrinol. 2012, 77, 132–138. [Google Scholar] [CrossRef] [PubMed]
- Castagna, M.G.; Maino, F.; Cipri, C.; Belardini, V.; Theodoropoulou, A.; Cevenini, G.; Pacini, F. Delayed risk stratification, to include the response to initial treatment (surgery and radioiodine ablation), has better outcome predictivity in differentiated thyroid cancer patients. Eur. J. Endocrinol. 2011, 165, 441–446. [Google Scholar] [CrossRef] [Green Version]
- Pitoia, F.; Bueno, F.; Urciuoli, C.; Abelleira, E.; Cross, G.; Tuttle, R.M. Outcomes of patients with differentiated thyroid cancer risk-stratified according to the American Thyroid Association and Latin American Thyroid Society risk of recurrence classification systems. Thyroid 2013, 23, 1401–1407. [Google Scholar] [CrossRef]
- Schmidt, M.; Bartenstein, P.; Bucerius, J.; Dietlein, M.; Drzezga, A.; Herrmann, K.; Lapa, C.; Lorenz, K.; Musholt, T.J.; Nagarajah, J. Individualized treatment of differentiated thyroid cancer: The value of surgery in combination with radioiodine imaging and therapy—A German position paper from Surgery and Nuclear Medicine. Nuklearmedizin 2022, 61, 87–96, Erratum in: Nuklearmedizin 2023, 62, 44. [Google Scholar] [CrossRef]
- Petranović Ovčariček, P.; Kreissl, M.C.; Campenni, A.; de Keizer, B.; Tuncel, M.; Vrachimis, A.; Deandreis, D.; Giovanella, L. SNMMI/EANM practice guideline vs. ETA Consensus Statement: Differences and similarities in approaching differentiated thyroid cancer management-the EANM perspective. Eur. J. Nucl. Med. 2022, 49, 3959–3963. [Google Scholar] [CrossRef]
- Perros, P.; Boealaert, K.; Colley, S.; Evans, C.; Evans, R.M.; Gerrard Ba, G.; Gilbert, J.; Harrison, B.; Johnson, S.J.; Giles, T.E.; et al. Guidelines for management of thyroid cancer. Clin. Endocrinol. 2014, 81 (Suppl. 1), 1–22. [Google Scholar] [CrossRef]
- Verburg, F.A.; Mäder, U.; Reiners, C.; Hänscheid, H. Long-term survival in differentiated thyroid cancer is worse after low-activity initial post-surgical 131I therapy in both high- and low-risk patients. J. Clin. Endocrinol. Metab. 2014, 99, 4487–4496. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tuttle, R.M.; Ahuja, S.; Avram, A.M.; Bernet, V.J.; Bourguet, P.; Daniels, G.H.; Dillehay, G.; Draganescu, C.; Flux, G.; Führer, D.; et al. Controversies, Consensus, and Collaboration in the Use of 131I Therapy in Differentiated Thyroid Cancer: A Joint Statement from the American Thyroid Association, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association. Thyroid 2019, 29, 461–470. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lamartina, L.; Durante, C.; Lucisano, G.; Grani, G.; Bellantone, R.; Lombardi, C.P.; Pontecorvi, A.; Arvat, E.; Felicetti, F.; Zatelli, M.C.; et al. Are Evidence-Based Guidelines Reflected in Clinical Practice? An Analysis of Prospectively Collected Data of the Italian Thyroid Cancer Observatory. Thyroid 2017, 27, 1490–1497. [Google Scholar] [CrossRef]
- Leboulleux, S.; Bournaud, C.; Chougnet, C.N.; Zerdoud, S.; Al Ghuzlan, A.; Catargi, B.; Do Cao, C.; Kelly, A.; Barge, M.L.; Lacroix, L.; et al. Thyroidectomy without Radioiodine in Patients with Low-Risk Thyroid Cancer. N. Engl. J. Med. 2022, 386, 923–932. [Google Scholar] [CrossRef] [PubMed]
- Tuncel, M.; Vrachimis, A.; Campenni, A.; de Keizer, B.; Verburg, F.A.; Kreissl, M.C.; Ovcaricek, P.P.; Geliashvili, T.; Giovanella, L. To give or not to give? A critical appraisal of a clinical trial on radioiodine treatment. Eur. J. Nucl. Med. Mol. Imaging 2022, 49, 3316–3319. [Google Scholar] [CrossRef] [PubMed]
- Sawka, A.M.; Brierley, J.D.; Tsang, R.W.; Thabane, L.; Rotstein, L.; Gafni, A.; Straus, S.; Goldstein, D.P. An updated systematic review and commentary examining the effectiveness of radioactive iodine remnant ablation in well-differentiated thyroid cancer. Endocrinol. Metab. Clin. N. Am. 2008, 37, 457–480. [Google Scholar] [CrossRef] [PubMed]
- Campennì, A.; Ruggeri, R.M.; Siracusa, M.; Giacoppo, G.; La Torre, F.; Saccomanno, A.; Alibrandi, A.; Dionigi, G.; Tuccari, G.; Baldari, S.; et al. Isthmus topography is a risk factor for persistent disease in patients with differentiated thyroid cancer. Eur. J. Endocrinol. 2021, 185, 397–404. [Google Scholar] [CrossRef]
- Van Velsen, E.F.S.; Visser, W.E.; Stegenga, M.T.; Mäder, U.; Reiners, C.; van Kemenade, F.J.; van Ginhoven, T.M.; Verburg, F.A.; Peeters, R.P. Finding the Optimal Age cutoff for the UICC/AJCC TNM Staging System in Patients with Papillary or Follicular Thyroid Cancer. Thyroid 2021, 31, 1041–1049. [Google Scholar] [CrossRef]
Low risk | – papillary thyroid cancer – no local or distant metastases – no remaining macroscopic tumor tissue – no invasion in loco-regional tissues or structures – no aggressive histology (e.g., tall cell, hobnail variant, columnar cell carcinoma) – if 131I is given: no radioiodine (RAI)-avid metastatic foci outside the thyroid bed – no vascular invasion – clinical N0 or ≤5 N1 micrometastases (<0.2 cm) – intrathyroidal, encapsulated follicular variant of papillary thyroid cancer – intrathyroidal, well-differentiated follicular thyroid cancer with capsular invasion and no or minimal (<4 foci) vascular invasion – intrathyroidal, papillary microcarcinoma, unifocal or multifocal, including BRAFV600E mutated (if known) |
Intermediate risk | – microscopic invasion of tumor into the perithyroidal soft tissues – RAI-avid metastatic foci in the neck – aggressive histology (e.g., tall cell, hobnail variant, columnar cell carcinoma) – papillary thyroid cancer with vascular invasion – clinical N1 or >5 pathologic N1 (<3 cm) – multifocal papillary microcarcinoma with extra thyroidal extension and BRAFV600E mutated (if known) |
High risk | – macroscopic invasion of tumor into the perithyroidal soft tissues – incomplete tumor resection – distant metastases – postoperative serum thyroglobulin suggestive of distant metastases – pathologic N1 with any metastatic lymph node ≥3 cm – follicular thyroid cancer with extensive vascular invasion (>4 foci) |
Excellent response |
|
|
Indeterminate response |
|
|
Biochemical incomplete response |
|
|
Structural incomplete response | structural or functional evidence of disease
| 50–85% continue to have persistent disease despite additional therapy
|
N = 121 | ||
---|---|---|
Age at diagnosis in years | Median 51 (range, 14–86) | |
Sex | Female Male | 85 36 |
Histology | Papillary Follicular Others | 108 7 6 |
n = 121 | ||
---|---|---|
TNM before RAI (8th edition) | T1 T2 T3 T4 | 61 40 18 2 |
N0/x N1 | 37/40 44 | |
M1 | 3 | |
AJCC/UICC classification stage | I II III Iva Ivb | 103 14 2 0 2 |
Initial ATA classification | Low risk Intermediate risk High risk | 83 19 19 |
Radioiodine therapy | Activity (in MBq) | 3.700 (2.000–11.000) |
Interval to surgery in months | 1 (1–7) | |
Thyroglobulin (not stimulated) (ng/mL) * | 1 (<0.04–20.626) | |
Thyroglobulin (stimulated) (ng/mL) * | 7.3 (<0.04–47.262) | |
Follow-up | Thyroglobulin (not stimulated) (ng/mL) * | <0.04 (<0.04–4046) |
Positive thyroglobulin antibodies | 6 patients | |
Cervical ultrasound | 112 patients | |
| ||
131I diagnostic scintigraphy | 92 patients | |
| ||
123I diagnostic scintigraphy | 1 patient; not suspicious, 17 months after RAI | |
Second RAI | 9 patients | |
| ||
18F-FDG-PET/CT | 16 patients | |
|
Excellent Response | Indeterminate Response | Biochemical Incomplete Response | Structural Incomplete Response | Total | |
---|---|---|---|---|---|
Low risk | 73/83 (88%) | 5/83 (6%) | 3/83 (4%) | 2/83 (2%) | 83 |
Intermediate risk | 12/19 (63%) | 2/19 (11%) | 1/19 (5%) | 4/19 (21%) | 19 |
High risk | 9/19 (47%) | 2/19 (10.5%) | 2/19 (10.5%) | 6/19 (32%) | 19 |
94 | 9 | 6 | 12 | 121 |
Population N = 108 | Different Age Cutoff Groups and ATA Risk Categories | |||
---|---|---|---|---|
<55 Years N = 69/108 (63%) | >55 Years N = 39/108 (37%) | <50 Years N = 46/108 (44%) | >50 Years N = 62/108 (56%) | |
Excellent response | 53/69 (77%) | 33/39 (84%) | 36/46 (78%) | 50/62 (81%) |
41/53 (77%) low risk 8/53 (15%) int. risk 4/53 (8%) high risk | 28/33 (85%) low risk 1/33 (3%) int. risk 4/33 (12%) high risk | 26/36 (72%) low risk 8/36 (22%) int. risk 2/36 (6%) high risk | 43/50 (86%) low risk 1/50 (2%) int. risk 6/50 (12%) high risk | |
Indeterminate response | 6/69 (9%) | 3/39 (8%) | 4/46 (9%) | 5/62 (8%) |
4/6 (67%) low risk 2/6 (33%) int. risk 0 high risk | 1/3 (33%) low risk 0 int. risk2/3 (67%) high risk | 3/4 (75%) low risk 1/4 (25%) int. risk 0 high risk | 2/5 (40%) low risk 1/5 (20%) int. risk 2/5 (40%) high risk | |
Biochemical incomplete response | 6/69 (9%) | 0 (0%) | 4/46 (9%) | 2/62 (3%) |
3/6 (50%) low risk 1/6 (17%) int. risk 2(6 (33%) high risk | 1/4 (25%) low risk 1/4 (25%) int. risk 2/4 (50%) high risk | 2/2 (100%) low risk | ||
Structural incomplete response | 4/69 (5%) | 3/39 (8%) | 2/46 (4%) | 5/62 (8%) |
0 low risk 1/4 (25%) int. risk 3/4 (75%) high risk | 1/3 (33.3%) low risk 1/3 (33.3%) int. risk 1/3 (33.3%) high risk | 0 low risk 0 int. risk 2/2 (100%) high risk | 1/5 (20%) low risk 2/5 (40%) int. risk 2/5 (40%) high risk | |
Low risk | 48/108 (45%) | 30/108 (28%) | 30/108 (28%) | 48/108 (45%) |
Int. risk | 12/108 (11%) | 2/108 (2%) | 10/108 (9%) | 4/108 (4%) |
High risk | 9/108 (8%) | 7/108 (6%) | 6/108 (5%) | 10/108 (9%) |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Eilsberger, F.; Kreissl, M.C.; Reiners, C.; Holzgreve, A.; Luster, M.; Pfestroff, A. Application of the American Thyroid Association Risk Assessment in Patients with Differentiated Thyroid Carcinoma in a German Population. Biomedicines 2023, 11, 911. https://doi.org/10.3390/biomedicines11030911
Eilsberger F, Kreissl MC, Reiners C, Holzgreve A, Luster M, Pfestroff A. Application of the American Thyroid Association Risk Assessment in Patients with Differentiated Thyroid Carcinoma in a German Population. Biomedicines. 2023; 11(3):911. https://doi.org/10.3390/biomedicines11030911
Chicago/Turabian StyleEilsberger, Friederike, Michael C. Kreissl, Christoph Reiners, Adrien Holzgreve, Markus Luster, and Andreas Pfestroff. 2023. "Application of the American Thyroid Association Risk Assessment in Patients with Differentiated Thyroid Carcinoma in a German Population" Biomedicines 11, no. 3: 911. https://doi.org/10.3390/biomedicines11030911
APA StyleEilsberger, F., Kreissl, M. C., Reiners, C., Holzgreve, A., Luster, M., & Pfestroff, A. (2023). Application of the American Thyroid Association Risk Assessment in Patients with Differentiated Thyroid Carcinoma in a German Population. Biomedicines, 11(3), 911. https://doi.org/10.3390/biomedicines11030911