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. 2021 Jun;10(3):198-207.
doi: 10.1159/000511708. Epub 2020 Dec 1.

Natural Course of the American Thyroid Association Response to Therapy Statuses (Dynamic Risk Stratification) in Differentiated Thyroid Cancer

Noha Mukhtar  1 , Hadeel Aljamei  1 , Abeer Aljomaiah  1 , Yosra Moria  1 , Ali S Alzahrani  1
Affiliations

Natural Course of the American Thyroid Association Response to Therapy Statuses (Dynamic Risk Stratification) in Differentiated Thyroid Cancer

Noha Mukhtar et al. Eur Thyroid J. 2021 Jun.

Abstract

The concept of response to therapy in differentiated thyroid cancer (DTC) was introduced as a dynamic risk stratification used to assess the status of the disease at the time of the evaluation during the follow-up and the risk of recurrence in the future. Our aim in this study was to evaluate the natural course over time of different response to therapy statuses.

Methods: We studied 501 nonselected DTC patients (102 males and 399 females) with a median age of 37 years (interquartile range [IQR] 29-48). All patients underwent near-total or total thyroidectomy followed by I-131 ablation (initial management).

Results: Of the 501 patients, 387 patients (77.2%) did not have any additional therapuetic interventions after the initial management. In this group, the response to therapy status at the time of the first evaluation after I-131 (median 17 months, IQR 14-22) was an excellent response in 258 (66.7%), an indeterminate response in 101 (26.1%), biochemically incomplete in 17 (4.4%), and structurally incomplete in 11 patients (2.8%). The status changed spontaneously without any intervention in many of them. At the last follow-up visit (median duration 101 months, IQR 71-126), 357 patients (92.2%) achieved an excellent response, 4 (1%) an indeterminate response, 8 (2.1%) a biochemically incomplete status, 16 (4.1%) a structurally incomplete status, and 2 (0.5%) died secondary to DTC with a structurally incomplete status. The response to therapy in the other 114 patients who underwent additional interventions changed from before intervention to the last evaluation as follows: excellent response, 0 to 60 patients (52.6%), indeterminate response, 20 (17.5%) to 1 patient (0.9%), biochemically incomplete 25 (21.9%) to 10 patients (9%), and structurally incomplete 69 (60.5%) to 43 patients (37.7%). Overall, at the last evaluation, 417 (83.2%) were in an excellent response, 5 (1%) in an indeterminate response, 18 (3.6%) in a biochemically incomplete status, 50 (10.2%) in a structurally incomplete status, and 11 (2.2%) died secondary to DTC with a structurally incomplete status.

Conclusions: The response to therapy at the initial evaluation is predictive of the long-term outcome. Most patients with the indeterminate response and some in the biochemically incomplete statuses spontaneously regress to an excellent status. Mortality and progression of DTC occur mostly in the structurally incomplete status.

Keywords: American Thyroid Association staging; Papillary thyroid cancer; Response to therapy; Thyroid cancer; Tumor node metastasis staging.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Overall design and the results of the study showing the initial number of patients, the excluded patients, the initial management, response to therapy at the first evaluation after thyroid surgery and I-131 ablation, the additional interventions for a subgroup of 114 patients, and the final response to therapy statuses at the last follow-up.
Fig. 2
Fig. 2
Kaplan-Meier analyses showing the disease-free probabilities based on the ATA risk stratification (a), the AJCC/TNM8 stages (b) and response to therapy statuses at the first evaluation after initial management (c). All of these risk stratification and staging systems correlated well with the final outcome (median duration of 105 months [IQR 71–132] after I-131 ablation/therapy). ATA, American Thyroid Association; AJCC TNM, American Joint Committee on Cancer Tumor Node Metastasis.
Fig. 3
Fig. 3
A summary diagram showing the changes in the numbers and percentages of patients in different response to therapy statuses at the first evaluation after the initial management at a median time of 17 months (IQR 14–22) after I-131 ablation and at the last follow-up visit (median duration 105 months [IQR 71–132] after I-131 ablation). IQR, interquartile range. *Including 11 patients who died with a structurally incomplete status.
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