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

Deborah van Dijk*, Andries H. Groen, Boukje A. C. van Dijk, Tim L. van Veen, Wim J. Sluiter, Thera P. Links, John T. H. M. Plukker

*Corresponding author for this work

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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.

Original languageEnglish
Pages (from-to)123-130
Number of pages8
JournalClinical Endocrinology
Early online date3-Jul-2022
DOIs
Publication statusPublished - Jan-2023

Keywords

  • de-escalation
  • differentiated thyroid cancer
  • follow-up
  • overtreatment
  • risk classification
  • thyroid cancer guidelines
  • undertreatment
  • RISK PAPILLARY MICROCARCINOMA
  • ASSOCIATION GUIDELINES
  • ACTIVE SURVEILLANCE
  • RADIOIODINE
  • MANAGEMENT
  • CARCINOMA
  • ABLATION
  • SURVIVAL
  • NODULES
  • SURGERY

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