Commentary: Re-recurrence after surgical management of recurrent thyroid cancer

In this issue of Surgery, Xu et al 1 Xu S. Li Q. Wang Z. et al. Evaluating and revising initial and response-to-therapy risk stratifications in patients with persistent/recurrent thyroid carcinoma. Surgery. 2021; 169: 837-843 Abstract Full Text Full Text PDF Scopus (3) Google Scholar from China offered an interesting discussion of the management and prognostic implications of recurrent/persistent thyroid cancer, including an evaluation of the risk stratification guidelines published by the American Thyroid Association (ATA) in 2015. 2 Haugen B.R. Alexander E.K. Bible K.C. et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016; 26: 1-133 Crossref PubMed Scopus (6845) Google Scholar The ATA recommends using several perioperative clinicopathological features available at the time of initial therapy to categorize the risk of recurrence into low, intermediate, and high groups, which we had previously referred to as good, bad, and ugly. Patients undergoing primary surgery for thyroid cancer should be stratified postoperatively based on a variety of prognostic factors, such as age, grade and size of the tumor, extrathyroidal extension (ETE), lymph node metastasis, distant metastasis, multifocality, lymphovascular invasion, and histologic type. The ATA initial risk stratification system integrates these initial risk factors into risk categories that can be used to predict the risk of disease recurrence, guide adjuvant therapy management decisions (such as the potential need for radioactive iodine therapy, external beam radiation, and extent of thyroid-stimulating hormone suppressive therapy that may be required), and provide insights into development of an individualized disease surveillance program that tailors the risk of recurrence to the intensity of follow-up. Evaluating the risk of re-recurrence in patients with persistent/recurrent thyroid carcinoma after initial reoperationSurgeryVol. 169Issue 4PreviewAlthough the 2015 American Thyroid Association guidelines proposed initial and response-to-therapy risk stratifications were adequately validated in untreated papillary thyroid cancer patients, it is still unknown how they work in persistent/recurrent papillary thyroid cancer patients. This study aimed to evaluate and revise the stratifications in these patients. Full-Text PDF