Background: In recent years, there has been a renewed interest in thyroid cancer management paradigms that use individualized risk assessments as the basis for treatment and follow-up recommendations. In this study, we assumed that the long-term follow-up of differentiated thyroid cancer patients might be better tailored by integrating the response to initial therapy with the America Thyroid Association (ATA) risk classes. Methods: This retrospective study included low- and intermediate-risk papillary thyroid cancer (PTC) patients followed up for a median time of 8 years and classified according to the response to initial therapy assessed 6–12 months after initial treatment. Results: After a median follow-up of 8 years, in the initial excellent response subgroup of PTC patients (n= 522), the rate of recurrent disease was significantly higher in intermediate-risk patients than in low-risk PTC patients (6.9% versus 1.2%,p= 0.0005). Similarly, in the initial biochemical incomplete response subgroup (n= 82), the rate of excellent response was significantly higher in low-risk PTC patients (58.0%) than in intermediate-risk PTC patients (33.3%) (p= 0.007). Finally, in the initial structural incomplete response subgroup (n= 66), the rate of excellent response was higher in low-risk patients (80.0%) than in intermediate-risk patients (46.4%) (p= 0.08). Moreover, all patients with initial indeterminate response had an excellent response at the last follow-up visit. ATA risk classes were independently associated with long-term outcome in each subgroup of patients classified dynamically after initial therapy and the overall prognostic performance, defined via ROC curve analysis, of response to initial therapy integrated with the ATA risk system (AUC: 0.89; 95% CI: 0.86–0.92) was significantly higher compared to the ATA risk stratification (AUC 0.69; 95% CI: 0.65–0.74,p< 0.001) or the dynamic risk stratification (DRS) systems alone (AUC: 0.86 95% CI: 0.82–0.90,p= 0.007). Conclusions: This study of a large cohort of PTC patients showed that the initial ATA risk criteria may be useful for improving the risk-adapted management of PTC patients based on the response to initial therapy.
背景：近年来，基于个体化风险评估制定治疗与随访方案的甲状腺癌管理模式重新受到关注。本研究假设，通过将初始治疗反应与美国甲状腺协会（ATA）风险分级相结合，可更好地为分化型甲状腺癌患者制定长期随访策略。方法：这项回顾性研究纳入中低风险甲状腺乳头状癌（PTC）患者，中位随访时间8年，根据初始治疗后6-12个月评估的治疗反应进行动态风险分层。结果：在中位8年随访后，初始治疗反应为"疗效优异"的PTC患者亚组（n=522）中，中风险患者的疾病复发率显著高于低风险患者（6.9%对1.2%，p=0.0005）。在初始"生化反应不全"亚组（n=82）中，低风险患者获得最终"疗效优异"的比例显著高于中风险患者（58.0%对33.3%，p=0.007）。在初始"结构反应不全"亚组（n=66）中，低风险患者获得"疗效优异"的比例亦高于中风险患者（80.0%对46.4%，p=0.08）。所有初始"反应不确定"患者末次随访时均达到"疗效优异"。通过ROC曲线分析显示，整合ATA风险系统与初始治疗反应的预后评估体系（AUC：0.89；95%CI：0.86-0.92）较单纯ATA风险分层（AUC：0.69；95%CI：0.65-0.74，p<0.001）或动态风险分层系统（AUC：0.86；95%CI：0.82-0.90，p=0.007）具有显著更优的总体预后判别效能。结论：这项大规模PTC队列研究表明，初始ATA风险分级结合治疗反应评估，可优化基于风险分层的PTC患者管理策略。
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