• Aldona Kowalska, Agnieszka Walczyk, Iwona Pałyga, Danuta Gąsior-Perczak, Klaudia Gadawska-Juszczyk, Monika Szymonek, Tomasz Trybek, Katarzyna Lizis-Kolus, Dorota Szyska-Skrobot, Estera Mikina, Stefan Hurej, Janusz Słuszniak, Ryszard Mężyk, and Stanisław Góźdź.
• Departments of Endocrinology, Holycross Cancer Centre, Kielce, Poland.
• Plos One. 2016 Jan 1; 11 (4): e0153242.

ContextThere has been a marked increase in the detection of differentiated thyroid carcinoma (DTC) over the past few years, which has improved the prognosis. However, it is necessary to adjust treatment and monitoring strategies relative to the risk of an unfavourable disease course.Materials And MethodsThis retrospective study examined data from 916 patients with DTC who received treatment at a single centre between 2000 and 2013. The utility of the American Thyroid Association (ATA) and the European Thyroid Association (ETA) recommended systems for early assessment of the risk of recurrent/persistent disease was compared with that of the recently recommended delayed risk stratification (DRS) system.ResultsThe PPV and NPV for the ATA (24.59% and 95.42%, respectively) and ETA (24.28% and 95.68%, respectively) were significantly lower than those for the DRS (56.76% and 98.5%, respectively) (p<0.0001). The proportion of variance for predicting the final outcome was 15.8% for ATA, 16.1% for ETA and 56.7% for the DRS. Recurrent disease was rare (1% of patients), and was nearly always identified in patients at intermediate/high risk according to the initial stratification (9/10 cases).ConclusionsThe DRS showed a better correlation with the risk of persistent disease than the early stratification systems and allows personalisation of follow-up. If clinicians plan to alter the intensity of surveillance, patients at intermediate/high risk according to the early stratification systems should remain within the specialized centers; however, low risk patients can be referred to endocrinologists or other appropriate practitioners for long-term follow-up, as these patients remained at low risk after risk re-stratification.

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