Dynamic risk stratification in papillary thyroid carcinoma measuring 1 to 4 cm

BACKGROUND AND OBJECTIVES

This study aimed to validate the dynamic risk stratification (DRS) system, evaluate its correlation with structural recurrence, and assess the clinicopathological risk factors associated with a nonexcellent response to initial therapy in patients with papillary thyroid cancer (PTC) measuring 1 to 4 cm.

METHODS

A total of 762 patients with classic PTC measuring 1 to 4 cm were classified into four categories based on their response to initial therapy 2 years postoperatively.

RESULTS

Structural recurrent disease occurred in 4.7%, 17.1%, 48.4%, and 83.9% of patients with excellent, indeterminate, biochemically incomplete, and structurally incomplete responses, respectively, at the time of the last follow-up. The response to initial therapy in the DRS was one of the independent risk factors for structural recurrence. The disease-free survival curves of patients with different responses showed significant differences (P < 0.001). Extensive extrathyroidal extension, lymph node (LN) metastasis, number of metastatic LNs greater than 2.0, metastatic LN ratio greater than 0.22, and extranodal extension were independent risk factors for nonexcellent response to initial therapy.

CONCLUSIONS

DRS can be a useful tool in predicting structural recurrence and guiding postoperative management and follow-up strategies in patients with PTC measuring 1 to 4 cm.