Real-World Performance of the American Thyroid Association Risk Estimates in Predicting 1-Year Differentiated Thyroid Cancer Outcomes: A Prospective Multicenter Study of 2000 Patients

Giorgio Grani, Maria Chiara Zatelli, Marco Alfò, Teresa Montesano, Massimo Torlontano, Silvia Morelli, Maurilio Deandrea, Alessandro Antonelli, Cecilia Francese, Graziano Ceresini, Fabio Orlandi, Carolina Adele Maniglia, Rocco Bruno, Salvatore Monti, Maria Giulia Santaguida, Andrea Repaci, Giovanni Tallini, Laura Fugazzola, Fabio Monzani, Raffaele GiubbiniRuth Rossetto, Caterina Mian, Anna Crescenzi, Dario Tumino, Loredana Pagano, Luciano Pezzullo, Celestino Pio Lombardi, Emanuela Arvat, Luisa Petrone, Maria Grazia Castagna, Giovanna Spiazzi, Domenico Salvatore, Domenico Meringolo, Erica Solaroli, Fabio Monari, Flavia Magri, Vincenzo Triggiani, Roberto Castello, Cesare Piazza, Roberta Rossi, Umberto Ferraro Petrillo, Sebastiano Filetti, Cosimo Durante

Research output: Contribution to journalArticlepeer-review


Background: One of the most widely used risk stratification systems for estimating individual patients' risk of persistent or recurrent differentiated thyroid cancer (DTC) is the American Thyroid Association (ATA) guidelines. The 2015 ATA version, which has increased the number of patients considered at low or intermediate risk, has been validated in several retrospective, single-center studies. The aims of this study were to evaluate the real-world performance of the 2015 ATA risk stratification system in predicting the response to treatment 12 months after the initial treatment and to determine the extent to which this performance is affected by the treatment center in which it is used. Methods: A prospective cohort of DTC patients collected by the Italian Thyroid Cancer Observatory web-based database was analyzed. We reviewed all records present in the database and selected consecutive cases that satisfied inclusion criteria: (i) histological diagnosis of DTC, with the exclusion of noninvasive follicular thyroid neoplasm with papillary-like nuclear features; (ii) complete data of the initial treatment and pathological features; and (iii) results of 1-year follow-up visit (6-18 months after the initial treatment), including all data needed to classify the estimated response to treatment. Results: The final cohort was composed of 2071 patients from 40 centers. The ATA risk of persistent/recurrent disease was classified as low in 1109 patients (53.6%), intermediate in 796 (38.4%), and high in 166 (8.0%). Structural incomplete responses were documented in only 86 (4.2%) patients: 1.5% in the low-risk, 5.7% in the intermediate-risk, and 14.5% in the high-risk group. The baseline ATA risk class proved to be a significant predictor of structural persistent disease, both for intermediate-risk (odds ratio [OR] 4.67; 95% confidence interval [CI] 2.59-8.43) and high-risk groups (OR 16.48; CI 7.87-34.5). Individual center did not significantly influence the prediction of the 1-year disease status. Conclusions: The ATA risk stratification system is a reliable predictor of short-term outcomes in patients with DTC in real-world clinical settings characterized by center heterogeneity in terms of size, location, level of care, local management strategies, and resource availability.

Original languageEnglish
JournalThyroid : official journal of the American Thyroid Association
Publication statusPublished - 2021


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