Improving the prediction of persistent and recurrent differentiated thyroid cancer using the American Thyroid Association 2015 risk stratification system

Georgios K Markantes; Meropi Karakioulaki; Stavroula Papanikolopoulou; Anastasia Theodoropoulou; Kostas B Markou; Apostolos G Vagenakis; Trifon Spyridonidis; Dimitrios G Goulis; Marina A Michalaki

doi:10.1007/s42000-021-00313-2

Improving the prediction of persistent and recurrent differentiated thyroid cancer using the American Thyroid Association 2015 risk stratification system

Hormones (Athens). 2021 Dec;20(4):761-768. doi: 10.1007/s42000-021-00313-2. Epub 2021 Aug 12.

Authors

Georgios K Markantes¹, Meropi Karakioulaki², Stavroula Papanikolopoulou², Anastasia Theodoropoulou¹, Kostas B Markou¹, Apostolos G Vagenakis¹, Trifon Spyridonidis³, Dimitrios G Goulis², Marina A Michalaki⁴

Affiliations

¹ Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece.
² 1st Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
³ Department of Nuclear Medicine, University Hospital of Patras, Patras, Greece.
⁴ Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece. mixmar@upatras.gr.

PMID: 34383288
DOI: 10.1007/s42000-021-00313-2

Abstract

Purpose: The 2015 American Thyroid Association risk stratification system (ATA RSS) is used in patients with differentiated thyroid carcinoma (DTC) to assess their risk of persistent/recurrent disease. Our aims were to validate the 2015 ATA RSS in a registry of DTC patients and to examine whether the addition of factors not included in it, such as pre-radioactive iodine therapy stimulated thyroglobulin (pre-RAI sTg), gender, and age could increase its predictive ability.

Methods: We studied 403 patients with DTC, treated at a tertiary center from 1990 to 2018 and subjected to total thyroidectomy. All patients had received RAI therapy, except those with low-risk papillary microcarcinoma.

Results: Of our patients, 81.9% were women and 91.1% had papillary thyroid carcinoma. After a median follow-up of 5.0 years, 53 cases of persistent and 21 cases of recurrent disease were recorded. The proportion of variance explained (PVE) regarding the outcome (presence or absence of recurrent/persistent disease) using the 2015 ATA RSS alone was 18.3% (persistence) and 16.9% (recurrence), increasing to 74.4% and 52.0%, respectively, when pre-RAI sTg was added to the logistic regression model. Gender and age were not associated with the disease outcome. In ROC analysis, pre-RAI sTg had a high predictive value for persistent (AUC 0.983, 95% CI 0.962-1.000) and recurrent disease (AUC 0.856, 95% CI 0.715-0.997). The optimal cut-offs and sensitivity, specificity, and positive and negative predictive value for pre-RAI sTg were the following: for persistence 12.75 ng/ml, 100%, 90.5%, 64%, and 100%, and for recurrence 8.05 ng/ml, 77.8%, 85.5%, 36.8%, and 97%.

Conclusions: The 2015 ATA RSS displayed moderate performance in predicting recurrent/persistent disease in patients with DTC, which improved with the inclusion of pre-RAI sTg values; pre-RAI sTg was an independent predictor of the disease outcome, with high negative prognostic value.

Keywords: ATA risk stratification system; Differentiated thyroid cancer; Pre-RAI stimulated thyroglobulin.

MeSH terms

Female
Humans
Iodine Radioisotopes*
Neoplasm Recurrence, Local
Retrospective Studies
Risk Assessment
Thyroglobulin / physiology
Thyroid Neoplasms* / surgery
Thyroid Neoplasms* / therapy
Thyroidectomy

Substances

Iodine Radioisotopes
Thyroglobulin