Skip to main content
Top

01-01-2016 | Endocrine cancers | Book chapter | Article

14. The Role of Risk Stratification in the Treatment of Well-Differentiated Thyroid Cancer

Author: Kepal N. Patel, M.D., F.A.C.S.

Publisher: Springer International Publishing

Abstract

The primary goal in the management of patients with well-differentiated thyroid cancer is to provide the best therapy with the least amount of morbidity. Initial therapy to remove all gross disease should be based on a risk adapted approach. The follow-up paradigm should incorporate the initial risk assessment, ongoing risk stratification, response to therapy variables, and disease-free survival. It is a dynamic process which helps ensure optimal patient care by allowing physicians to identify patients who are at high risk for disease recurrence. These patients may benefit from closer surveillance, testing, and treatment. More importantly, this dynamic risk adapted paradigm will help avoid over-treatment in patients who are at low risk of recurrence.
Literature
1.
Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery. 1988;104(6):947–53.PubMed
2.
Cady B et al. Further evidence of the validity of risk group definition in differentiated thyroid carcinoma. Surgery. 1985;98(6):1171–8.PubMed
3.
Dean DS, Hay ID. Prognostic indicators in differentiated thyroid carcinoma. Cancer Control. 2000;7(3):229–39.PubMed
4.
Hay ID et al. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery. 1993;114(6):1050–7. Discussion 1057–8.PubMed
5.
Lang BH et al. Staging systems for papillary thyroid carcinoma: a review and comparison. Ann Surg. 2007;245(3):366–78.PubMedCentralCrossRefPubMed
6.
Mazzaferri EL, Jhiang SM. Differentiated thyroid cancer long-term impact of initial therapy. Trans Am Clin Climatol Assoc. 1995;106:151–68. Discussion 168–70.PubMedCentralPubMed
7.
Shaha AR, Shah JP, Loree TR. Risk group stratification and prognostic factors in papillary carcinoma of thyroid. Ann Surg Oncol. 1996;3(6):534–8.CrossRefPubMed
8.
Sherman SI et al. Prospective multicenter study of thyroiscarcinoma treatment: initial analysis of staging and outcome. National Thyroid Cancer Treatment Cooperative Study Registry Group. Cancer. 1998;83(5):1012–21.CrossRefPubMed
9.
Tuttle RM. Risk-adapted management of thyroid cancer. Endocr Pract. 2008;14(6):764–74.CrossRefPubMed
10.
Tuttle RM et al. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid. 2010;20(12):1341–9.CrossRefPubMed
11.
Tuttle RM, Fagin JA. Can risk-adapted treatment recommendations replace the ‘one size fits all’ approach for early-stage thyroid cancer patients? Oncology (Williston Park). 2009;23(7):592. 600, 603.
12.
Rivera M et al. Molecular genotyping of papillary thyroid carcinoma follicular variant according to its histological subtypes (encapsulated vs infiltrative) reveals distinct BRAF and RAS mutation patterns. Mod Pathol. 2010;23(9):1191–200.PubMedCentralCrossRefPubMed
13.
Gupta S et al. Follicular variant of papillary thyroid cancer: encapsulated, nonencapsulated, and diffuse: distinct biologic and clinical entities. Arch Otolaryngol Head Neck Surg. 2012;138(3):227–33.CrossRefPubMed
14.
Liu J et al. Follicular variant of papillary thyroid carcinoma: a clinicopathologic study of a problematic entity. Cancer. 2006;107(6):1255–64.CrossRefPubMed
15.
Nikiforov YE, Nikiforova MN. Molecular genetics and diagnosis of thyroid cancer. Nat Rev Endocrinol. 2011;7(10):569–80.CrossRefPubMed
16.
Nikiforova MN, Nikiforov YE. Molecular genetics of thyroid cancer: implications for diagnosis, treatment and prognosis. Expert Rev Mol Diagn. 2008;8(1):83–95.CrossRefPubMed
17.
Xing M, Haugen BR, Schlumberger M. Progress in molecular-based management of differentiated thyroid cancer. Lancet. 2013;381(9871):1058–69.PubMedCentralCrossRefPubMed
18.
Xing M. Molecular pathogenesis and mechanisms of thyroid cancer. Nat Rev Cancer. 2013;13(3):184–99.PubMedCentralCrossRefPubMed
19.
Xing M et al. BRAF V600E and TERT promoter mutations cooperatively identify the most aggressive papillary thyroid cancer with highest recurrence. J Clin Oncol. 2014;32(25):2718–26.PubMedCentralCrossRefPubMed
20.
Liu X et al. TERT promoter mutations and their association with BRAF V600E mutation and aggressive clinicopathological characteristics of thyroid cancer. J Clin Endocrinol Metab. 2014;99(6):E1130–6.PubMedCentralCrossRefPubMed
21.
Tuttle RM, Leboeuf R. Follow up approaches in thyroid cancer: a risk adapted paradigm. Endocrinol Metab Clin North Am. 2008;37(2):419–35. ix–x.CrossRefPubMed
22.
Tuttle RM, Leboeuf R, Shaha AR. Medical management of thyroid cancer: a risk adapted approach. J Surg Oncol. 2008;97(8):712–6.CrossRefPubMed
23.
American Thyroid Association Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167–214.CrossRef
24.
Mazzaferri EL, Kloos RT. Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab. 2001;86(4):1447–63.CrossRefPubMed
25.
Hay ID et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940–1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg. 2002;26(8):879–85.CrossRefPubMed
26.
Bilimoria KY et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007;246(3):375–81. Discussion 381–4.PubMedCentralCrossRefPubMed
27.
Shaha AR, Shah JP, Loree TR. Low-risk differentiated thyroid cancer: the need for selective treatment. Ann Surg Oncol. 1997;4(4):328–33.CrossRefPubMed
28.
Castagna MG et al. Limited value of repeat recombinant human thyrotropin (rhTSH)-stimulated thyroglobulin testing in differentiated thyroid carcinoma patients with previous negative rhTSH-stimulated thyroglobulin and undetectable basal serum thyroglobulin levels. J Clin Endocrinol Metab. 2008;93(1):76–81.CrossRefPubMed
29.
Chiovato L et al. Disappearance of humoral thyroid autoimmunity after complete removal of thyroid antigens. Ann Intern Med. 2003;139(5 Pt 1):346–51.CrossRefPubMed
30.
Kloos RT, Mazzaferri EL. A single recombinant human thyrotropin-stimulated serum thyroglobulin measurement predicts differentiated thyroid carcinoma metastases three to five years later. J Clin Endocrinol Metab. 2005;90(9):5047–57.CrossRefPubMed
31.
Mazzaferri EL et al. A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab. 2003;88(4):1433–41.CrossRefPubMed
32.
Spencer CA. Serum thyroglobulin measurements: clinical utility and technical limitations in the management of patients with differentiated thyroid carcinomas. Endocr Pract. 2000;6(6):481–4.PubMed
33.
Toubeau M et al. Predictive value for disease progression of serum thyroglobulin levels measured in the postoperative period and after (131)I ablation therapy in patients with differentiated thyroid cancer. J Nucl Med. 2004;45(6):988–94.PubMed
34.
Durante C et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab. 2006;91(8):2892–9.CrossRefPubMed
35.
Pacini F et al. Recombinant human thyrotropin-stimulated serum thyroglobulin combined with neck ultrasonography has the highest sensitivity in monitoring differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2003;88(8):3668–73.CrossRefPubMed
36.
Robbins RJ, Larson SM. The value of positron emission tomography (PET) in the management of patients with thyroid cancer. Best Pract Res Clin Endocrinol Metab. 2008;22(6):1047–59.CrossRefPubMed
37.
Robbins RJ et al. Real-time prognosis for metastatic thyroid carcinoma based on 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography scanning. J Clin Endocrinol Metab. 2006;91(2):498–505.CrossRefPubMed