Veen, T.L. van der (2019) Evaluatie en klinische relevantie van de huidige Nederlandse richtlijn voor hetgedifferentieerd schildkliercarcinoom ten opzichte van de internationaal toegepaste American Thyroid Association (ATA)-guideline. thesis, Medicine.
Full text available on request.Abstract
Introduction The first guidelines for differentiated thyroid cancer (DTC) in the Netherlands was formed in 2007 (NL-07) with a revised version in 2015 (NL-15). Nowadays there is a lot of discussion about the intensity (aggressiveness) of treatment (i.e. total thyroidectomy with radioactive iodine) for patients with DTC in the Netherlands. There is a growing attention and research to potentially less aggressive treatment in the last decades. Besides, DTC is a relatively rare disease with good prognosis and it is hard to perform good prospective studies regarding different treatment approaches. Regrettable, in most cases we still need retrospective analyses to evaluate current treatment options. The aim of this study is to evaluate NL-15 and to compare this treatment guideline to ATA-15. Patients and methods Patients diagnosed with DTC between January 2007 and March 2017, were included from an preexisting UMCG thyroid-database. For each guideline (ATA-15, NL-15 and NL-07), patients have been scored according to the risk classification, under-treatment, over-treatment and a probably adequate treatment. The study population was than divided in group A, where patients were scored as low risk by all three guidelines, group B, where they were scored as high risk by all three guidelines and a group C with rather differences in risk classifications. The McNemar test was used to compare the degree of under- and over-treatment according to both Dutch guidelines with that in ATA-15. Results If NL-15 was compared with ATA-15 in the whole study population, we found significantly more under-treatment in ATA-15 and significantly more over-treatment in NL-15, but also significantly more adequate treatment in NL-15. When NL-07 was compared with ATA-15 results were basically the same as when NL-15 was compared to ATA-15, although the degree of under- and over-treatment were slightly more apart. Most of these differences were due to patients of group C. No differences were found in group B. In group A there was more over-treatment in NL-15 and NL-07 and more adequate treatment in ATA-15. Conclusion This study shows that patients with DTC are presumably treated too aggressively according to current guidelines in the Netherlands, where ATA-15 seems to be less aggressive. Especially in the congruent low-risk group the less aggressive approach of ATA-15 seems to be more adequate. However, DTC patients in the discongruent group were more often undertreated when using the ATA-15 compared to treatment according to the NL-15 guidelines. These results support the current discussion about the de-escalation of treatment in patients with DTC in the Netherlands.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisors: and Plukker, Prof. Dr. J.T.M. oncologisch chirurg and Groen, A.H. Md. PhD student and Statistische adviezen: and Sluiter, Dr. W.J. afd. endocrinologie and Locatie: and Universitair Medisch Centrum Groningen, afdelingen chirurgis |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/672 |
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