ETA2022 Oral Presentations Oral Session 9: Thyroid Cancer Clinical (5 abstracts)
Interim outcome analysis of prospective ATA recurrence risk (RR) stratification for postoperative treatment and follow up of differentiated thyroid cancer (DTC)
Jiahui Wu 1 , Xun Yang Hu 2 , Sana Ghaznavi 2 , Susan Kinnear 2 , Christopher Symonds 2 , Peter Grundy 2 , Vicky Parkins 2 , Priyanka Sharma 1 , Debbie Lamb 1 , Moosa Khalil 3 , Martin Hyrcza 3 , Shamir Chandarana 4 , Janice Pasieka 4 , Adrian Harvey 4 , Joseph Warshawski 4 , Robert Hart 4 , Michael Deutschman 4 , Derrick Randall 4 & Ralf Paschke 5
1University of Calgary, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, Calgary, Canada; 2University of Calgary, Department of Medicine, Section of Endocrinology, Calgary, Canada; 3University of Calgary, Cumming School of Medicine, Department of Pathology and Laboratory Medicine, Calgary, Ab, Canada; 4University of Calgary, Department of Surgery, Cumming School of Medicine, Calgary, Canada; 5Dept. of Medicine, Cumming School of Medicine,, University of Calgary, Calgary, Canada
Objective: The 2016 ATA RR assessment recommendations for patients with DTC were based on retrospective studies. We present the first outcomes of a prospective assessment of thyroid cancer management according to the ATA RR stratification.
Methods: Using the Calgary prospective thyroid cancer database, we identified 612 patients with differentiated thyroid cancer (DTC) treated at our centre between April 2017 and December 2021. Each case was reviewed by the thyroid cancer (endocrinology) triage group and patients were prospectively assigned a modified ATA recurrence risk and AJCC 8th edition stage. Initial risk stratification guided the indication of radioiodine dose and other adjuvant therapies. Patients were assessed for their response to treatment (RTT) at 6, 12, and 24 months postoperatively.
Results: The 612 patients of our study cohort comprise 435 (71%) females and 177 (29%) males with a median age at diagnosis of 48 years. Of these patients, the ATA recurrence risk was as follows: low-risk n= 323 (53%), intermediate-risk n=178 (29%), high-risk n=111 (18%). 280 patients (46%) received total thyroidectomy (TTX) and radioiodine (RAI), 230 (38%) received TTX alone, and 102 (17%) received lobectomy alone. 542 patients (89%) had at least 1-year follow-up. The RTT at 1 year was excellent response to treatment (ERT) in 86% of patients with lobectomy, 75% for patients with TTX only, and 53% for TTX & RAI (Table 1). Among the patients who were initially deemed to be low risk of recurrence, 79% had ERT, 17% had indeterminate response (IRT), 3% had biochemical incomplete response (BIR), and 1% had structural incomplete response (SIR). These are significantly better interim outcomes compared to the intermediate-risk group, which showed 60% ERT, 26% IRT, 7% BIR, and 7% SIR. Lastly, the high-risk group had the worst outcomes, with 42% ERT, 18% IRT, 11% BIR, and 29% SIR.
| All | TTX + RAI | TTX only | Lobectomy | |
| Patients Number | 542 | 240 (44%) | 209 (39%) | 93 (17%) |
| ERT | 363 (67%) | 126 (53%) | 157 (75%) | 80 (86%) |
| IRT | 107 (20%) | 59 (25%) | 38 (18%) | 10 (11%) |
| BIR | 30 (6%) | 21 (9%) | 7 (3%) | 2 (2%) |
| SIR | 42 (8%) | 34 (14%) | 7 (3%) | 1 (1%) |
Conclusions: The 2015 ATA risk stratification system is a useful tool for predicting disease status at 1-year post-treatment in patients with DTC. The 2015 ATA guidelines and modified ATA recurrence risk stratification treatment recommendations reduce thyroid cancer overtreatment by including lobectomy as a definitive treatment option for low-risk thyroid cancers and selective use of RAI for intermediate and high-risk patients.
Volume 84
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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