title: Delayed risk stratification, to include the response to initial treatment (surgery and radioiodine ablation), has better outcome predictivity in differentiated thyroid cancer patients.
abstract: BACKGROUND
  After initial treatment, differentiated thyroid cancer (DTC) patients are stratified as low and high risk based on clinical/pathological features. Recently, a risk stratification based on additional clinical data accumulated during follow-up has been proposed.
  
  
  OBJECTIVE
  To evaluate the predictive value of delayed risk stratification (DRS) obtained at the time of the first diagnostic control (8-12 months after initial treatment).
  
  
  METHODS
  We reviewed 512 patients with DTC whose risk assessment was initially defined according to the American (ATA) and European Thyroid Association (ETA) guidelines. At the time of the first control, 8-12 months after initial treatment, patients were re-stratified according to their clinical status: DRS.
  
  
  RESULTS
  Using DRS, about 50% of ATA/ETA intermediate/high-risk patients moved to DRS low-risk category, while about 10% of ATA/ETA low-risk patients moved to DRS high-risk category. The ability of the DRS to predict the final outcome was superior to that of ATA and ETA. Positive and negative predictive values for both ATA (39.2 and 90.6% respectively) and ETA (38.4 and 91.3% respectively) were significantly lower than that observed with the DRS (72.8 and 96.3% respectively, P<0.05). The observed variance in predicting final outcome was 25.4% for ATA, 19.1% for ETA, and 62.1% for DRS.
  
  
  CONCLUSIONS
  Delaying the risk stratification of DTC patients at a time when the response to surgery and radioiodine ablation is evident allows to better define individual risk and to better modulate the subsequent follow-up.
authors.affiliation: Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, Section of Endocrinology and Metabolism, Viale Bracci 1, 53100 Siena, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Castagna
authors.forename: Fabio
authors.initials: F
authors.lastname: Maino
authors.forename: Claudia
authors.initials: C
authors.lastname: Cipri
authors.forename: Valentina
authors.initials: V
authors.lastname: Belardini
authors.forename: Alexandra
authors.initials: A
authors.lastname: Theodoropoulou
authors.forename: Gabriele
authors.initials: G
authors.lastname: Cevenini
authors.forename: Furio
authors.initials: F
authors.lastname: Pacini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013964:Thyroid Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes