Dynamic Risk Stratification Tool Effective in Predicting Postoperative Tall Cell Variant Papillary Thyroid Cancer Course

by Linda Kossoff •

How effective is dynamic risk stratification (DRS) in predicting the postoperative course in patients who have tall cell variant (TCV) papillary thyroid cancer (PTC)?

BOTTOM LINE

A DRS tool showed that patients with TCV PTC who achieve an excellent overall response to therapy at any point during follow-up have significantly improved outcomes.

BACKGROUND: TCV is a subtype of PTC associated with aggressive tumor behavior, advanced stage, and high recurrence/mortality rates. Established risk stratification systems have been used to assess patient and tumor characteristics at time of diagnosis or surgery but have not taken treatment impact into account.

STUDY DESIGN: Retrospective chart review.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.

SYNOPSIS: Researchers identified and retroactively reviewed the charts of 94 patients with TCV PTC who underwent total thyroidectomy with radioactive iodine ablation from 1998 to 2020 and who met study criteria. Biochemical, structural, and overall treatment response were determined for each patient. Primary outcomes were locoregional and distant recurrence, presence of disease at final follow-up, need for additional intervention, and disease-specific mortality. Overall, the cohort had a five-year locoregional recurrence rate of 24.0%, a five-year distant recurrence rate of 10.4%, and a 6.4% mortality rate over the follow-up period. Patients with TCV who were stratified as having an excellent overall response to treatment had lower rates of locoregional recurrence than patients who had indeterminate, biochemical incomplete, and structural incomplete responses. The same was true for distant recurrence. An excellent response was also associated with lower rates of presence of disease at final follow-up, need for additional intervention, and disease-specific mortality. Study limitations included its retrospective nature.

CITATION: Zimmer D, Plitt G, Prendes B, et al. Utilizing dynamic risk stratification in patients with tall cell variant papillary thyroid cancer. Laryngoscope. 2023;133:2430–2438.