BACKGROUND: Papillary thyroid cancer has an established favorable outcome with a 10-year overall survival of more than 90%, but the chances of recurrences are as high as 20%. Traditionally, all intermediary-risk and high-risk category patients undergo vigorous follow-up. A sensitive risk stratification system may predict the patients requiring stringent postoperative surveillance. METHODS: The present study is a retrospective cohort study of papillary thyroid cancer operated and systematically followed for a median period of 135.5 months. The outcomes at the end of the follow-up period were determined based on American Thyroid Association (ATA) guidelines (2015). We used American Joint Committee on Cancer (AJCC) risk stratification (8 th edition), ATA risk stratification (2015), and a modified dynamic risk stratification system. The disease status in the first year of the follow-up was used for reclassification. RESULTS: The overall survival was 95.1%, but the incidence of adverse outcomes which included disease-specific mortality, structural incomplete responses, and biochemical incomplete responses was 11.2% (n: 23). The modified dynamic risk stratification had higher accuracy in predicting the outcomes. CONCLUSION: Patients who had excellent responses in the first year of follow-up are unlikely to develop adverse events in the future. However, those who had overt or evident distant metastases at the time of diagnosis require vigilant surveillance.
Nair et al. (Thu,) studied this question.