Pediatric DTC: which risk stratification system is best?

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  • The American Thyroid Association (ATA) risk classification and dynamic risk stratification (DRS) systems are evaluated based on their associations with clinical outcomes.

Why this matters

  • Risk stratification aids postoperative treatment strategies, but the best classification system is unclear.

Key results

  • Both the ATA and DRS systems showed significant associations between risk classification and DFS (P<.001 for both).
  • Intermediate and low-risk patients had similar risk for recurrent/persistent disease (HR, 4.43; P=.161) in the ATA system.
  • High-risk patients had higher risk for recurrent/persistent disease (HR, 18.35; P=.005) compared with low-risk patients in the ATA system.
  • Indeterminate (HR, 10.20; P=.045) and structural incomplete (HR, 98.68; P<.001) patients had increased risk for recurrent/persistent disease based on response to initial therapy in the DRS system.

Study design

  • 77 pediatric patients with differentiated thyroid cancer (DTC) who underwent thyroid surgery were assessed for clinical outcomes and associations with ATA and DRS risk groups.
  • Funding: Asan Institute for Life Sciences.


  • Retrospective study.
  • Small patient sample size.