Prognostic Factors Improving ATA Risk System and Dynamic Risk Stratification in Low- and Intermediate-Risk DTC Patients
© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com..
CONTEXT: American Thyroid Association (ATA) guidelines do not consider age at diagnosis as a prognostic factor on the estimation of the risk of persistent/recurrent disease in differentiated thyroid carcinoma (DTC) patients. While age at diagnosis has already been assessed in high-risk patients, it remains to be established in low- and intermediate-risk patients.
OBJECTIVE: The aim of our study was to investigate the role of age as a prognostic factor in the short- and long-term outcome of DTC patients classified at low and intermediate risk according to the ATA stratification risk system.
METHODS: We retrospectively evaluated 863 DTC patients (mean follow-up: 10 ± 6.2 years) 52% classified as low (449/863) and 48% as intermediate risk (414/863). For each ATA-risk class patients were divided into subgroups based on age at diagnosis (<55 or ≥55 years).
RESULTS: In the intermediate-risk group, patients aged 55 years or older had a higher rate of structural disease (11.6% vs 8.9%), recurrent disease (4.1% vs 0.7%), and death (4.1% vs 1%) when compared with younger patients (<55 years) (P = .007). Multivariate analysis confirmed that older age at diagnosis (odds ratio [OR] = 3.9; 95% CI, 1.9-8.6; P < .001) was an independent risk factor for worse long-term outcome together with response to initial therapy (OR = 13.0; 95% CI, 6.3-27.9; P < .001), and T (OR = 32; 95% CI, 1.4-7.1; P = .005) and N category (OR = 2.3; 95% CI, 1.1-5.0; P = .03). Nevertheless, a negative effect of older age was documented only in the subgroup of intermediate DTC patients with persistent structural disease after initial therapy. Indeed, the rate of worse long-term outcome rose from 13.3% in the whole population of intermediate DTC patients to 47.8% in patients with persistent structural disease after initial therapy (P < .001) and to 80% in patients older than 55 years and persistent structural disease after initial therapy (P = .02).
CONCLUSION: Our results suggest that age at diagnosis further predict individual outcomes in Intermediate-Risk DTC allowing ongoing management to be tailored accordingly.
| Errataetall: |
CommentIn: J Clin Endocrinol Metab. 2023 Dec 20;:. - PMID 38118019 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:109 |
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| Enthalten in: |
The Journal of clinical endocrinology and metabolism - 109(2024), 3 vom: 20. Feb., Seite 722-729 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Maino, Fabio [VerfasserIn] |
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| Links: |
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| Themen: |
ATA intermediate risk |
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| Anmerkungen: |
Date Completed 21.02.2024 Date Revised 21.02.2024 published: Print CommentIn: J Clin Endocrinol Metab. 2023 Dec 20;:. - PMID 38118019 Citation Status MEDLINE |
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| doi: |
10.1210/clinem/dgad591 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM362981191 |
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| 500 | |a Date Revised 21.02.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: J Clin Endocrinol Metab. 2023 Dec 20;:. - PMID 38118019 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com. | ||
| 520 | |a CONTEXT: American Thyroid Association (ATA) guidelines do not consider age at diagnosis as a prognostic factor on the estimation of the risk of persistent/recurrent disease in differentiated thyroid carcinoma (DTC) patients. While age at diagnosis has already been assessed in high-risk patients, it remains to be established in low- and intermediate-risk patients | ||
| 520 | |a OBJECTIVE: The aim of our study was to investigate the role of age as a prognostic factor in the short- and long-term outcome of DTC patients classified at low and intermediate risk according to the ATA stratification risk system | ||
| 520 | |a METHODS: We retrospectively evaluated 863 DTC patients (mean follow-up: 10 ± 6.2 years) 52% classified as low (449/863) and 48% as intermediate risk (414/863). For each ATA-risk class patients were divided into subgroups based on age at diagnosis (<55 or ≥55 years) | ||
| 520 | |a RESULTS: In the intermediate-risk group, patients aged 55 years or older had a higher rate of structural disease (11.6% vs 8.9%), recurrent disease (4.1% vs 0.7%), and death (4.1% vs 1%) when compared with younger patients (<55 years) (P = .007). Multivariate analysis confirmed that older age at diagnosis (odds ratio [OR] = 3.9; 95% CI, 1.9-8.6; P < .001) was an independent risk factor for worse long-term outcome together with response to initial therapy (OR = 13.0; 95% CI, 6.3-27.9; P < .001), and T (OR = 32; 95% CI, 1.4-7.1; P = .005) and N category (OR = 2.3; 95% CI, 1.1-5.0; P = .03). Nevertheless, a negative effect of older age was documented only in the subgroup of intermediate DTC patients with persistent structural disease after initial therapy. Indeed, the rate of worse long-term outcome rose from 13.3% in the whole population of intermediate DTC patients to 47.8% in patients with persistent structural disease after initial therapy (P < .001) and to 80% in patients older than 55 years and persistent structural disease after initial therapy (P = .02) | ||
| 520 | |a CONCLUSION: Our results suggest that age at diagnosis further predict individual outcomes in Intermediate-Risk DTC allowing ongoing management to be tailored accordingly | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ATA intermediate risk | |
| 650 | 4 | |a ATA low risk | |
| 650 | 4 | |a PTC | |
| 650 | 4 | |a age diagnosis | |
| 700 | 1 | |a Botte, Monica |e verfasserin |4 aut | |
| 700 | 1 | |a Dalmiglio, Cristina |e verfasserin |4 aut | |
| 700 | 1 | |a Valerio, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a Brilli, Lucia |e verfasserin |4 aut | |
| 700 | 1 | |a Trimarchi, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Mattii, Elisa |e verfasserin |4 aut | |
| 700 | 1 | |a Cartocci, Alessandra |e verfasserin |4 aut | |
| 700 | 1 | |a Castagna, Maria Grazia |e verfasserin |4 aut | |
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