Purpose: 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 cancer patients (DTC). While age at diagnosis has already been assessed in high-risk patients, it remains to be established in Low and Intermediate-Risk patients. 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 Intermediate-Risk group, patients ≥55 years had higher rate of structural disease (11.6% versus 8.9%), recurrent disease (4.1% versus 0.7%) and death (4.1% versus 1%) when compared with younger patients (<55years) (p=0.007). Multivariate analysis confirmed that older age at diagnosis (OR=3.9, 95%-CI: 1.9-8.6, p<0.001) 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<0.001), T (OR=32, 95%-CI: 1.4-7.1, p=0.005) and N category (OR=2.3, 95%-CI: 1.1-5.0, p=0.03). Nevertheless, a negative impact 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 patient with persistent structural disease after initial therapy (p<0.001) and to 80% in patients older than 55 years and persistent structural disease after initial therapy (p=0.02). Conclusions: Our results suggest that age at diagnosis further predict individual outcomes in Intermediate-Risk DTC allowing ongoing management to be tailored accordingly.
Maino, F., Botte, M., Dalmiglio, C., Valerio, L., Brilli, L., Trimarchi, A., et al. (2024). Prognostic Factors Improving ATA Risk System and Dynamic Risk Stratification in low and Intermediate DTC Patients. THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM, 109(3), 722-729 [10.1210/clinem/dgad591].
Prognostic Factors Improving ATA Risk System and Dynamic Risk Stratification in low and Intermediate DTC Patients
Maino, FabioWriting – Original Draft Preparation
;Botte, MonicaMembro del Collaboration Group
;Dalmiglio, CristinaMembro del Collaboration Group
;Valerio, LauraMembro del Collaboration Group
;Trimarchi, AndreaMembro del Collaboration Group
;Mattii, ElisaMembro del Collaboration Group
;Cartocci, AlessandraFormal Analysis
;Castagna, Maria GraziaSupervision
2024-01-01
Abstract
Purpose: 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 cancer patients (DTC). While age at diagnosis has already been assessed in high-risk patients, it remains to be established in Low and Intermediate-Risk patients. 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 Intermediate-Risk group, patients ≥55 years had higher rate of structural disease (11.6% versus 8.9%), recurrent disease (4.1% versus 0.7%) and death (4.1% versus 1%) when compared with younger patients (<55years) (p=0.007). Multivariate analysis confirmed that older age at diagnosis (OR=3.9, 95%-CI: 1.9-8.6, p<0.001) 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<0.001), T (OR=32, 95%-CI: 1.4-7.1, p=0.005) and N category (OR=2.3, 95%-CI: 1.1-5.0, p=0.03). Nevertheless, a negative impact 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 patient with persistent structural disease after initial therapy (p<0.001) and to 80% in patients older than 55 years and persistent structural disease after initial therapy (p=0.02). Conclusions: Our results suggest that age at diagnosis further predict individual outcomes in Intermediate-Risk DTC allowing ongoing management to be tailored accordingly.File | Dimensione | Formato | |
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https://hdl.handle.net/11365/1248176