title: The Delayed Risk Stratification System in the Risk of Differentiated Thyroid Cancer Recurrence.
abstract: BACKGROUND
  There 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.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  The 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).
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Departments of Endocrinology, Holycross Cancer Centre, Kielce, Poland.
authors.forename: Aldona
authors.identifier: http://orcid.org/0000-0001-5647-5898
authors.initials: A
authors.lastname: Kowalska
authors.affiliation: Departments of Endocrinology, Holycross Cancer Centre, Kielce, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Walczyk
authors.affiliation: Departments of Endocrinology, Holycross Cancer Centre, Kielce, Poland.
authors.forename: Iwona
authors.initials: I
authors.lastname: Pałyga
authors.affiliation: Departments of Endocrinology, Holycross Cancer Centre, Kielce, Poland.
authors.forename: Danuta
authors.initials: D
authors.lastname: Gąsior-Perczak
authors.affiliation: Departments of Endocrinology, Holycross Cancer Centre, Kielce, Poland.
authors.forename: Klaudia
authors.initials: K
authors.lastname: Gadawska-Juszczyk
authors.affiliation: Departments of Endocrinology, Holycross Cancer Centre, Kielce, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Szymonek
authors.affiliation: Departments of Endocrinology, Holycross Cancer Centre, Kielce, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Trybek
authors.affiliation: Departments of Endocrinology, Holycross Cancer Centre, Kielce, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Lizis-Kolus
authors.affiliation: Departments of Endocrinology, Holycross Cancer Centre, Kielce, Poland.
authors.forename: Dorota
authors.initials: D
authors.lastname: Szyska-Skrobot
authors.affiliation: Departments of Endocrinology, Holycross Cancer Centre, Kielce, Poland.
authors.forename: Estera
authors.initials: E
authors.lastname: Mikina
authors.affiliation: Departments of Endocrinology, Holycross Cancer Centre, Kielce, Poland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hurej
authors.affiliation: Department of Surgical Oncology, Holycross Cancer Centre, Kielce, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Słuszniak
authors.affiliation: Department of Cancer Epidemiology, Holycross Cancer Centre, Kielce, Poland.
authors.forename: Ryszard
authors.initials: R
authors.lastname: Mężyk
authors.affiliation: Department of Clinical Oncology; Holycross Cancer Centre, Kielce, Poland.|The Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland.
authors.forename: Stanisław
authors.initials: S
authors.lastname: Góźdź
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000473:pathology / Q000628:therapy*; D013965:Thyroidectomy; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes