A Three-Domain Scoring System to Customize the Risk of Relapse of Differentiated Thyroid Carcinoma

SIMPLE SUMMARY: In this study, we have identified and validated a large series of patients affected by DTC, and created a three-domain scoring system able to identify the risk of persistence-relapse of disease after initial treatment (e.g., thyroidectomy and RAI). This three-domain system includes potential prognostic factors such as demographic (age and gender) and RAI-related (pre-RAI Tg levels and the post-therapeutic (131)I WBS) data. This score is easy to calculate and interpret, as it provides a score ranging from 0 to 100; it allows clinicians to identify those patients who need stricter clinical surveillance or proper treatment due to a risk of disease persistence/relapse. This prognostic system can be used to semi-quantify the recurrence risk. ABSTRACT: Purpose: the validation of a new scoring model considering the principal risk factors of differentiated thyroid cancer (DTC) relapse. Methods: we evaluated all DTC patients treated with thyroidectomy and radioactive iodine (RAI) therapy. Three domains were considered: the demographic domain (age and gender), the surgical domain (histology and the American Thyroid Association risk categories), and the RAI-related domain (pre-RAI thyroglobulin and post-therapeutic (131)I whole-body scan). The progression-free survival was assessed. The patients’ sample was randomly split into a training and validation set. The three-domain score was calculated as the weighted sum of the levels of each significant factor, then scaled to an integer range (0–100) and, finally, stratified into terciles: mild risk 0–33, moderate risk 34–66, and severe risk 67–100. Results: 907 DTC patients were included. The RAI-related domain was the most relevant factor in the score calculation. The tercile stratification identified significantly different survival curves: patients within the two upper terciles showed approximately 6 to 30 times more progressive risk than patients at mild risk. Conclusion: we have validated a three-domain scoring system and the principal impact on this score is provided by the peri-RAI findings, whose prognostic role seems to be essential in risk identification.