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1. A Prospective Multicenter Study Examining the Relationship Between Thyroid Cancer Treatment Outcomes and the Presence of Autoimmune Thyroiditis.

Author

De Leo, Simone, D'Elia, Silvia, Grani, Giorgio, Dondi, Francesco, Bertagna, Francesco, Puxeddu, Efisio, Morelli, Silvia, Piovesan, Alessandro, Nervo, Alice, Zatelli, Maria Chiara, Gagliardi, Irene, Samà, Maria Teresa, Aimaretti, Gianluca, Crocetti, Umberto, Massa, Michela, Deandrea, Maurilio, Retta, Francesca, Pagano, Loredana, Rossi, Mattia, and Solaroli, Erica

Subjects
AUTOIMMUNE thyroiditis, THYROIDITIS, PROPENSITY score matching, TREATMENT effectiveness, CANCER treatment, THYROID cancer, AUTOIMMUNITY
Abstract

Background: There is some controversy on the potential relationship between autoimmune processes and clinicopathologic features as well as prognosis of differentiated thyroid cancer (DTC), and the evidence is limited by its largely retrospective nature. We examined the relationship between the presence of autoimmune thyroiditis (AT) and 1-year thyroid cancer treatment outcomes in a large multicenter study using prospectively collected data. Methods: We included data from consecutive DTC patients enrolled in the Italian Thyroid Cancer Observatory (ITCO) database (NCT04031339). We divided the groups according to the presence (AT) or absence (no autoimmune thyroiditis [noAT]) of associated AT. We used propensity score matching to compare the clinical features and outcomes between the two groups at 1-year follow-up. Results: We included data from 4233 DTC patients, including 3172 (75%) females. The American Thyroid Association (ATA) risk levels were as follows: 51% (2160/4233) low risk, 41.3% (1750/4233) intermediate risk, and 7.6% (323/4233) high risk. There were 1552 patients (36.7%) who had AT. Before propensity score matching, AT patients were significantly younger and had a smaller and bilateral tumor (p < 0.0001). Patients with AT more frequently fell into the low- and intermediate-risk categories, while the ATA high risk was more frequent among noAT patients (p = 0.004). After propensity score matching, patients with AT more frequently showed evidence of disease (structural/biochemical incomplete response) versus excellent/indeterminate response, compared with patients without AT (7.3% vs. 4.5%, p = 0.001), with an odds ratio of 1.86 ([confidence interval: 1.3–2.6], p = 0.0001). However, when considering only structural persistence as the outcome, no statistically significant differences were observed between patients with or without AT (3.4% vs. 2.7%, p = 0.35). The elevated risk associated with the ATA intermediate and high risk at diagnosis remained consistently statistically significant. Conclusions: In this large prospective series, biochemical persistence was more frequent, at 1-year follow-up, in AT patients. However, there was no significant association between the presence of AT and structural persistence of disease. These findings may be explained by the presence of a residual thyroid tissue. [ABSTRACT FROM AUTHOR]

Published
2023
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2. Real-World Performance of the American Thyroid Association Risk Estimates in Predicting 1-Year Differentiated Thyroid Cancer Outcomes: A Prospective Multicenter Study of 2000 Patients

Author

Laura Fugazzola, Cecilia Francese, Silvia Morelli, Andrea Repaci, Luisa Petrone, Marco Alfò, Fabio Orlandi, Carolina Adele Maniglia, Emanuela Arvat, Teresa Montesano, Caterina Mian, Giorgio Grani, Maria Chiara Zatelli, R. Rossetto, Maria Grazia Castagna, Massimo Torlontano, Dario Tumino, Fabio Monari, Maria Giulia Santaguida, Erica Solaroli, Domenico Salvatore, Graziano Ceresini, Cesare Piazza, Roberto Castello, Raffaele Giubbini, Loredana Pagano, Domenico Meringolo, Sebastiano Filetti, Salvatore Monti, Giovanna Spiazzi, Vincenzo Triggiani, Flavia Magri, Anna Crescenzi, Giovanni Tallini, Rocco Bruno, Luciano Pezzullo, Cosimo Durante, Celestino Pio Lombardi, Fabio Monzani, Alessandro Antonelli, Maurilio Deandrea, Umberto Ferraro Petrillo, Roberta Elisa Rossi, Grani, Giorgio, Zatelli, Maria Chiara, Alfò, Marco, Montesano, Teresa, Torlontano, Massimo, Morelli, Silvia, Deandrea, Maurilio, Antonelli, Alessandro, Francese, Cecilia, Ceresini, Graziano, Orlandi, Fabio, Maniglia, Carolina Adele, Bruno, Rocco, Monti, Salvatore, Santaguida, Maria Giulia, Repaci, Andrea, Tallini, Giovanni, Fugazzola, Laura, Monzani, Fabio, Giubbini, Raffaele, Rossetto, Ruth, Mian, Caterina, Crescenzi, Anna, Tumino, Dario, Pagano, Loredana, Pezzullo, Luciano, Lombardi, Celestino Pio, Arvat, Emanuela, Petrone, Luisa, Castagna, Maria Grazia, Spiazzi, Giovanna, Salvatore, Domenico, Meringolo, Domenico, Solaroli, Erica, Monari, Fabio, Magri, Flavia, Triggiani, Vincenzo, Castello, Roberto, Piazza, Cesare, Rossi, Roberta, Ferraro Petrillo, Umberto, Filetti, Sebastiano, and Durante, Cosimo

Subjects
Male, Time Factors, Databases, Factual, Settore MED/18 - CHIRURGIA GENERALE, Endocrinology, Diabetes and Metabolism, differentiated thyroid cancer, evidence-based guidelines, clinical practice, risk stratification, medicine.disease_cause, Iodine Radioisotopes, 0302 clinical medicine, Endocrinology, Risk Factors, thyroid cancer, Prospective Studies, LS4_3, Prospective cohort study, Thyroid cancer, Thyroid, Cell Differentiation, evidence-based guideline, Middle Aged, Treatment Outcome, medicine.anatomical_structure, Italy, 030220 oncology & carcinogenesis, Cohort, Thyroidectomy, Female, evidence based guidelines, Adult, medicine.medical_specialty, 030209 endocrinology & metabolism, Risk Assessment, Decision Support Techniques, NO, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, medicine, Humans, Thyroid Neoplasms, Pathological, Thyroid neoplasm, Settore MED/06 - ONCOLOGIA MEDICA, business.industry, Odds ratio, medicine.disease, Confidence interval, Lymph Node Excision, Neoplasm Recurrence, Local, Radiopharmaceuticals, business
Abstract

Background: One of the most widely used risk stratification systems for estimating individual patients' risk of persistent or recurrent differentiated thyroid cancer (DTC) is the American Thyroid Association (ATA) guidelines. The 2015 ATA version, which has increased the number of patients considered at low or intermediate risk, has been validated in several retrospective, single-center studies. The aims of this study were to evaluate the real-world performance of the 2015 ATA risk stratification system in predicting the response to treatment 12 months after the initial treatment and to determine the extent to which this performance is affected by the treatment center in which it is used. Methods: A prospective cohort of DTC patients collected by the Italian Thyroid Cancer Observatory web-based database was analyzed. We reviewed all records present in the database and selected consecutive cases that satisfied inclusion criteria: (i) histological diagnosis of DTC, with the exclusion of noninvasive follicular thyroid neoplasm with papillary-like nuclear features; (ii) complete data of the initial treatment and pathological features; and (iii) results of 1-year follow-up visit (6-18 months after the initial treatment), including all data needed to classify the estimated response to treatment. Results: The final cohort was composed of 2071 patients from 40 centers. The ATA risk of persistent/recurrent disease was classified as low in 1109 patients (53.6%), intermediate in 796 (38.4%), and high in 166 (8.0%). Structural incomplete responses were documented in only 86 (4.2%) patients: 1.5% in the low-risk, 5.7% in the intermediate-risk, and 14.5% in the high-risk group. The baseline ATA risk class proved to be a significant predictor of structural persistent disease, both for intermediate-risk (odds ratio [OR] 4.67; 95% confidence interval [CI] 2.59-8.43) and high-risk groups (OR 16.48; CI 7.87-34.5). Individual center did not significantly influence the prediction of the 1-year disease status. Conclusions: The ATA risk stratification system is a reliable predictor of short-term outcomes in patients with DTC in real-world clinical settings characterized by center heterogeneity in terms of size, location, level of care, local management strategies, and resource availability.

Published
2021

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