The ITCO provides no guidance or restrictions in terms of patient management to the participating centers, since the database is designed to provide a picture of real-world practices. In conclusion, the ATA risk stratification system is a reliable predictor of short-term outcomes in patients with DTC in real-world clinical settings characterized by appreciable treatment-center heterogeneity in terms of size, location, level of care, diagnostic resources, and local management strategies. Our findings demonstrate that the ATA risk stratification system for recurrent/persistent disease is indeed a reliable predictor at the 1-year follow-up evaluation, independent of treatment centers. As shown in Table 3, the ATA risk class assigned at baseline proved to be a significant predictor of the response to treatment observed at the 1-year follow-up visit. It is important to note, however, that most DTC recurrences are identified within the first 5 years of follow-up after initial treatment (31). Moreover, recent evidence suggests that persistent disease observed at the 1-year follow-up visit is associated with worse outcomes than “recurrences” identified later (12). Prediction of this early outcome may thus have particular clinical relevance.
These expected benefits must, however, be weighed against the risk of missing those thyroid cancers that warrant intensive therapeutic efforts and close post-treatment surveillance due to their intrinsic biologic aggressiveness. On 5 February 2008, he played in a friendly with France B against Congo DR team where he was substituted at halftime. The estimated level of risk was determined by the study team in accordance with the 2009 ATA guidelines (3) and relevant modifications in the 2015 update (1). Classification was based on the data available immediately after the initial treatment (Fig. 1). When treatment consisted of lobectomy followed by completion thyroidectomy, maillot marseille 2022 we considered pathologic data on tissues collected during both surgical procedures. Born in France, Riyad Mahrez joined Leicester from La Harve in 2014. He helped Leicester Town to win the Premiership in 2015-2016. He won the PFA Players’ Player of the Year, and was a member of the Premier League PFA Team of the Year as he helped Leicester City win the Premier League. The Italian Thyroid Cancer Observatory (ITCO) web-based database was opened in 2013 at the Thyroid Cancer Center of the Sapienza University of Rome (the network’s coordinating center).
Cases are inputted in the database at the time of the initial treatment in the reporting ITCO center, or when the patient begins follow-up in the reporting center within 12 months after undergoing initial treatment in a non-ITCO center. These were classified as excellent, biochemical incomplete, structural incomplete, or indeterminate on the basis of data collected during the clinical evaluation carried out at the 1-year follow-up visit. FIG. 2. Prevalence of patients classified as low, intermediate, and high risk, and their rates of structural persistent disease. The current study is based on a large, contemporary cohort of patients with prospectively collected data in many thyroid centers across Italy, including academic and nonacademic institutions, to validate the ATA risk stratification system in predicting persistent disease at the 1-year follow-up visit. Each case record contains information on patient demographics and biometrics, circumstances of the diagnosis, tumor pathology, surgical and radioactive iodine (RAI) treatments, as well as the results of periodic follow-up examinations. Importantly, it supports clinicians’ efforts to develop personalized treatment and follow-up strategies (4,16). Most cases can be safely managed with less extensive surgery, more selective use of RAI therapy, and relatively relaxed follow-up schedules.
Our aims were as follows: (i) to evaluate the performance of the 2015 ATA risk stratification system in predicting the response to treatment documented ∼12 months after the initial disease treatment; and (ii) to determine the extent to which this performance is affected by the treatment center itself. The ordinal response was categorized in descending order of desirability as excellent, indeterminate, biochemical incomplete, or structural incomplete. A revised version of this system was included in the ATA guidelines published in 2016 (1). The criteria for classifying the risk of recurrence as high in this version are substantially more restrictive compared with the previous ones and, as a result, the number of patients who will be considered at low or intermediate risk has increased. These data included imaging findings (cervical ultrasound in all patients, and RAI scintigraphy in selected individuals), basal or stimulated serum thyroglobulin (Tg) levels, and anti-Tg antibody (TgAb) levels. We also assessed whether the performance of the initial persistent disease risk estimate was significantly influenced by the practices of individual reporting centers, which included both academic and nonacademic health care facilities distributed throughout Italy (Table 1). Some potential biases (such as the case-mix of patients treated, surgical volumes, and different tools used) are difficult to document but can potentially influence both the initial risk estimation and the subsequent assessment of the response to treatment.
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