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The following is a summary of “Prognostic Factors Improving ATA Risk System and Dynamic Risk Stratification in Low- and Intermediate-Risk DTC Patients,” published in the March 2024 issue of Endocrinology by Maino, et al.

For a study, researchers sought to investigate the role of age as a prognostic factor in the short- and long-term outcomes of patients with differentiated thyroid carcinoma (DTC) classified at low and intermediate risk according to the American Thyroid Association (ATA) stratification risk system.

A retrospective analysis was conducted on 863 patients with DTC and a mean follow-up of 10 ± 6.2 years, of whom 52% were classified as low risk and 48% as intermediate risk according to ATA guidelines. Patients in each ATA risk class were stratified into subgroups based on age at diagnosis (<55 or ≥55 years).

In the intermediate-risk group, patients aged 55 years or older exhibited higher rates of structural disease (11.6% vs 8.9%), recurrent disease (4.1% vs 0.7%), and mortality (4.1% vs 1%) compared to younger patients (<55 years) (P = .007). Multivariate analysis confirmed that older age at diagnosis (odds ratio [OR] = 3.9; 95% CI, 1.9-8.6; P < .001) was an independent risk factor for worse long-term outcomes, along with response to initial therapy (OR = 13.0; 95% CI, 6.3-27.9; P < .001), and T (OR = 32; 95% CI, 1.4-7.1; P = .005) and N category (OR = 2.3; 95% CI, 1.1-5.0; P = .03). Notably, the negative impact of older age was observed primarily in the subgroup of intermediate-risk patients with DTC with persistent structural disease after initial therapy. The rate of worse long-term outcomes increased from 13.3% in the overall population of intermediate-risk patients with DTC to 47.8% in patients with persistent structural disease after initial therapy (P < .001) and further to 80% in patients older than 55 years with persistent structural disease after initial therapy (P = .02).

The findings suggested that age at diagnosis can further predict individual outcomes in intermediate-risk patients with DTC , enabling tailored management strategies based on age-specific risk profiles.

Reference: academic.oup.com/jcem/article-abstract/109/3/722/7299436