Dynamic risk stratification in papillary thyroid carcinoma measuring 1 to 4 cm

J Surg Oncol. 2018 Sep;118(4):636-643. doi: 10.1002/jso.25182. Epub 2018 Aug 16.


Background and objectives: This study aimed to validate the dynamic risk stratification (DRS) system, evaluate its correlation with structural recurrence, and assess the clinicopathological risk factors associated with a nonexcellent response to initial therapy in patients with papillary thyroid cancer (PTC) measuring 1 to 4 cm.

Methods: A total of 762 patients with classic PTC measuring 1 to 4 cm were classified into four categories based on their response to initial therapy 2 years postoperatively.

Results: Structural recurrent disease occurred in 4.7%, 17.1%, 48.4%, and 83.9% of patients with excellent, indeterminate, biochemically incomplete, and structurally incomplete responses, respectively, at the time of the last follow-up. The response to initial therapy in the DRS was one of the independent risk factors for structural recurrence. The disease-free survival curves of patients with different responses showed significant differences (P < 0.001). Extensive extrathyroidal extension, lymph node (LN) metastasis, number of metastatic LNs greater than 2.0, metastatic LN ratio greater than 0.22, and extranodal extension were independent risk factors for nonexcellent response to initial therapy.

Conclusions: DRS can be a useful tool in predicting structural recurrence and guiding postoperative management and follow-up strategies in patients with PTC measuring 1 to 4 cm.

Keywords: classic papillary thyroid cancer; dynamic risk stratification; nonexcellent response; risk factors.

MeSH terms

  • Adult
  • Carcinoma, Papillary / pathology*
  • Carcinoma, Papillary / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Lymph Nodes / pathology*
  • Lymph Nodes / surgery
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / pathology*
  • Neoplasm Recurrence, Local / surgery
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Survival Rate
  • Thyroid Neoplasms / pathology*
  • Thyroid Neoplasms / surgery
  • Thyroidectomy / mortality*