Risk Stratification in Differentiated Thyroid Cancer

• Risk stratification in differentiated thyroid cancer has traditionally used a relatively small set of clinical and pathological factors to create models that predict disease-specific mortality or overall survival:
  • Although clinically useful, these models provided static estimates of risk with information available within the first few months of initial therapy and demonstrated suboptimal, long-term outcome predictions for any individual patient

• Over the last decade, additional models have been developed that provide predictive information with regard to other clinically relevant outcomes, such as:
  • The risk of having persistent disease after initial therapy
  • The risk of structural or biochemical disease recurrence
  • The likelihood of going into remission following initial therapy in adult patients with thyroid cancer

• Furthermore, rather than using information that is only available at one particular point in time, these new models emphasize the importance of dynamic risk assessment:
  • Where the initial risk assessment is modified over time as new data become available
• These dynamic risk assessments allow us to:
  • Integrate response to therapy assessments with the underlying individual tumor biology:
    • To provide real-time risk assessments at any point in the course of the patient’s disease
• Thus, the modern view of risk stratification begins with:
  • The identification of a suspicious nodule (peri-diagnostic period) and continues through the phases of:
    • Diagnosis
    • Treatment
    • Adjuvant therapy
    • Follow-up

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