ATA staging may better predict thyroid cancer recurrence using age cutoff of 55 years
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Adults with differentiated thyroid cancer aged at least 55 years are more likely to experience disease recurrence and at a quicker rate than those who are younger, supporting the use of age as a factor in risk assessment, according to findings published in Thyroid.
“The age cutoff adopted in the eighth edition of thyroid TNM (tumor, lymph node, metastasis) staging system for differentiated thyroid cancer patients at risk of death — ie, 55 years — is also alone able to identify patients at higher risk of structural relapse,” Pierpaolo Trimboli, MD, of the clinic for nuclear medicine and competence center for thyroid disease at the Imaging Institute of Southern Switzerland and Ente Ospedaliero Cantonale in Bellinzona, Switzerland, and colleagues wrote. “Applying this age cutoff to the American Thyroid Association risk stratification system significantly improves the selection of cases at highest risk of relapse.”
Trimboli and colleagues used data from 1,603 adults with differentiated thyroid cancer who underwent thyroidectomy and radioiodine therapy (median age, 49 years; 74% women) to determine rates of disease recurrence and disease-free survival. The researchers also used the 2015 ATA guidelines to determine the guideline-supported level of recurrence risk as high, intermediate or low.
Among the entire cohort, 8.3% of participants experienced recurrence. Participants who experienced recurrence were older than participants who did not experience recurrence (median, 52 years vs. 48 years; P = .01).
Differentiated thyroid cancer recurrence occurred in 12.02% of those older than 55 years, who had a median of 41 months of disease-free survival. Recurrence occurred in 6.61% of those younger than 55 years, who had a median of 47 months of disease-free survival.
“Age at differentiated thyroid carcinoma diagnosis was a significant risk factor of structural cancer relapse,” the researchers wrote. “Because the ATA risk stratification system already includes several clinical, pathological, molecular and imaging characteristics, this finding suggests that age at diagnosis should be considered an additional feature for stratifying the initial risk of patients.”
According to the researchers, recurrence risk was greater for those older than 55 years vs. those younger than 55 years (HR = 1.78; 95% CI, 1.23-1.56), but this was primarily driven by comparisons of those the ATA guidelines deemed at high risk (HR = 2.15; 95% CI, 2.01-4.53). The researchers also noted “the ATA risk classification was the strongest predictor of relapse,” but that there was also an association between being older than 55 years and disease recurrence (HR = 1.6; 95% CI, 1.13-2.26).
“Both ATA risk assessment and the 55-year age cutoff proved to be reliable and independent risk factors for identifying differentiated thyroid carcinomas with the highest likelihood of structural relapse,” the researchers wrote. “These data may also guide the careful management and follow-up of the elderly patients, who are often frail and have comorbidities and are not amenable to an aggressive therapeutic approach after the initial treatment.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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