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The outcome of treatment in differentiated thyroid cancer according to recommendations in current Dutch and American guidelines.


ABSTRACT:

Objective

Assessment of treatment outcome in current de-escalation for differentiated thyroid cancer (DTC) according to the 2015 Dutch thyroid cancer guidelines (NL-15) and American Thyroid Association guidelines (ATA-15).

Design

Retrospectively, the recommendations of the NL-15 and ATA-15 guidelines were evaluated to estimate potentially adequate, under- and overtreatment of DTC in patients treated in the University Medical Center Groningen between 2007 and 2017.

Patients

A total of 240 patients with a cT1-T3aN0-1aM0 DTC fulfilled the inclusion criteria.

Measurements

After actual treatment was given, patients were again categorized according to both guidelines into low, intermediate, or high-risk based on tumour status. Next, they were categorized into a congruent low-risk (n = 60), congruent high-risk (n = 73), or incongruent risk group (n = 107). Follow-up data were used to estimate the proportion of potentially adequate, under-, and overtreatment according to both guidelines.

Results

Comparing treatment recommended by NL-15 and ATA-15 showed significantly more over- and adequate treatment when following NL-15 recommendations, and more undertreatment following ATA-15 (all: p < .001). Subanalysis of the congruent low-risk group showed overtreatment in 64% when following NL-15 guidelines (p < .001). No treatment differences were found in the congruent high-risk group. Undertreatment was most often seen in the incongruent risk group when following ATA-15 (p < .001).

Conclusions

Low-risk patients were treated too aggressively when following NL-15 recommendations, where the less aggressive ATA-15 approach seemed more adequate. Treatment of intermediate risk DTC patients varies greatly, with a relative higher rate of undertreatment according to the recommendations of the ATA-15, advocating further refining of the risk classification in this patient group.

SUBMITTER: van Dijk D 

PROVIDER: S-EPMC10087791 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Publications

The outcome of treatment in differentiated thyroid cancer according to recommendations in current Dutch and American guidelines.

van Dijk Deborah D   Groen Andries H AH   van Dijk Boukje A C BAC   van Veen Tim L TL   Sluiter Wim J WJ   Links Thera P TP   Plukker John T H M JTHM  

Clinical endocrinology 20220816 1


<h4>Objective</h4>Assessment of treatment outcome in current de-escalation for differentiated thyroid cancer (DTC) according to the 2015 Dutch thyroid cancer guidelines (NL-15) and American Thyroid Association guidelines (ATA-15).<h4>Design</h4>Retrospectively, the recommendations of the NL-15 and ATA-15 guidelines were evaluated to estimate potentially adequate, under- and overtreatment of DTC in patients treated in the University Medical Center Groningen between 2007 and 2017.<h4>Patients</h4>  ...[more]

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