Response to Initial Therapy Predicts Clinical Outcomes in Medullary Thyroid Cancer

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dc.contributor.author Lindsey, Susan C. [UNIFESP]
dc.contributor.author Ganly, Ian
dc.contributor.author Palmer, Frank
dc.contributor.author Tuttle, R. Michael
dc.date.accessioned 2016-01-24T14:40:01Z
dc.date.available 2016-01-24T14:40:01Z
dc.date.issued 2015-02-01
dc.identifier http://dx.doi.org/10.1089/thy.2014.0277
dc.identifier.citation Thyroid. New Rochelle: Mary Ann Liebert, Inc, v. 25, n. 2, p. 242-249, 2015.
dc.identifier.issn 1050-7256
dc.identifier.uri http://repositorio.unifesp.br/handle/11600/38718
dc.description.abstract Background: Risk stratification in medullary thyroid cancer (MTC) has traditionally relied on standardized anatomic staging systems that, despite providing valuable prognostic information, do not adequately predict the risk of persistent or recurrent disease. As dynamic risk stratification has been demonstrated to be clinically valuable in nonmedullary thyroid cancer, we adapted our response to therapy definitions in order to apply them to MTC. in this study, we evaluate and compare the clinical utility of our previously proposed MTC response to therapy stratification with a traditional standardized anatomic staging system.Methods: Both the Tumor, Node, Metastasis/American Joint Cancer Committee (TNM/AJCC) staging system and our previously proposed response to initial therapy staging system was evaluated in 287 MTC patients followed for a median of five years.Results: the TNM/AJCC staging system provided adequate risk stratification with regard to disease-specific mortality and the likelihood of having no evidence of disease at final follow-up, but did not adequately stratify patients with regard to the likelihood of having structural persistent disease, biochemical persistent disease, or recurrence. However, the response to initial therapy risk stratification system provided clinically useful risk stratification with regard to disease-specific mortality, the likelihood of having no evidence of disease at final follow-up, the likelihood of having a biochemical persistent disease at final follow-up, and the likelihood of having structural persistent disease at final follow-up. Furthermore, the response to therapy risk stratification system demonstrated a higher proportion of variance explained (54.3%) than the TNM/AJCC system (23.9%).Conclusion: Our data demonstrate that a dynamic risk stratification system that uses response to therapy variables to adjust risk estimates over time provides more useful clinical prognostic information than static initial anatomic staging in MTC thyroid cancer. en
dc.description.sponsorship Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
dc.format.extent 242-249
dc.language.iso eng
dc.publisher Mary Ann Liebert, Inc
dc.relation.ispartof Thyroid
dc.rights Acesso restrito
dc.title Response to Initial Therapy Predicts Clinical Outcomes in Medullary Thyroid Cancer en
dc.type Artigo
dc.contributor.institution Universidade Federal de São Paulo (UNIFESP)
dc.contributor.institution Mem Sloan Kettering Canc Ctr
dc.description.affiliation Universidade Federal de São Paulo, Escola Paulista Med, Dept Med, Lab Mol & Translat Endocrinol, São Paulo, Brazil
dc.description.affiliation Mem Sloan Kettering Canc Ctr, Dept Head & Neck Surg, New York, NY 10021 USA
dc.description.affiliation Mem Sloan Kettering Canc Ctr, Serv Endocrinol, New York, NY 10021 USA
dc.description.affiliationUnifesp Universidade Federal de São Paulo, Escola Paulista Med, Dept Med, Lab Mol & Translat Endocrinol, São Paulo, Brazil
dc.description.sponsorshipID FAPESP: 09/50575-4
dc.identifier.doi 10.1089/thy.2014.0277
dc.description.source Web of Science
dc.identifier.wos WOS:000349012300014



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