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Dynamic Risk Stratification in Stage I Papillary Thyroid Cancer Patients Younger Than 45 Years of Age.

Dynamic Risk Stratification in Stage I Papillary Thyroid Cancer Patients Younger Than 45 Years of Age.
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Sung TY, Cho JW, Lee YM, Lee YH, Kwon H, Jeon MJ, Kim WG, Choi YJ, Song DE, Chung KW, Yoon JH, Hong SJ,


Sung TY, Cho JW, Lee YM, Lee YH, Kwon H, Jeon MJ, Kim WG, Choi YJ, Song DE, Chung KW, Yoon JH, Hong SJ, (click to view)

Sung TY, Cho JW, Lee YM, Lee YH, Kwon H, Jeon MJ, Kim WG, Choi YJ, Song DE, Chung KW, Yoon JH, Hong SJ,

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Thyroid : official journal of the American Thyroid Association 2017 10 1727(11) 1400-1407 doi 10.1089/thy.2017.0199

Abstract
BACKGROUND
This study validated the dynamic risk stratification (DRS) system with regard to its association with structural recurrence and risk factors associated with non-excellent responses in patients <45 years with stage I classical papillary thyroid cancer (PTC). METHODS
This historical cohort study included 598 patients with stage I classical PTC <45 years of age treated with total thyroidectomy followed by radioactive iodine remnant ablation (n = 440), total thyroidectomy without radioactive iodine remnant ablation (n = 23), and thyroid lobectomy alone (n = 135). RESULTS
The median follow-up period was 123 months. Structural recurrence occurred in 4.2% (n = 18/432) of the patients with an excellent response, 17.1% (18/105) of patients with an indeterminate response, 44.7% (17/38) of patients with a biochemically incomplete response, and 82.6% (19/23) of patients with a structurally incomplete response (p < 0.001) during the follow-up. The disease-free survival curves of each response showed significant differences (p < 0.001). Extensive extrathyroidal extension and extranodal extension were the independent risk factors associated with non-excellent response (p < 0.05). CONCLUSIONS
DRS may reduce unnecessary additional treatments by reclassifying initial risk estimates of structural recurrence. Furthermore, applying the risk factors associated with non-excellent response to initial therapy may be a more useful and viable surrogate of the risk for structural recurrence in stage I PTC patients <45 years of age.

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