{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T09:34:51Z","timestamp":1793266491001,"version":"4.5.0"},"reference-count":26,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"The First Affiliated Hospital of Xiamen University Investigator-Initiated Trial Fund","award":["XMFHIIT-2023SL059"],"award-info":[{"award-number":["XMFHIIT-2023SL059"]}],"id":[{"id":"https:\/\/ror.org\/0006swh35","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Xiamen Healthcare Guidance Project","award":["NO.3502Z2022ZD1002"],"award-info":[{"award-number":["NO.3502Z2022ZD1002"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The 2025 American Thyroid Association (ATA) guidelines introduced significant modifications to the initial risk stratification system for differentiated thyroid cancer (DTC). However, the real-world prognostic performance and stage migration effects of these updates compared with the 2015 system remain unevaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study at a tertiary referral center in China. Adult patients who underwent initial thyroidectomy for pathologically confirmed DTC between January 2008 and December 2018 were included, with follow-up extending through October 30, 2025. We compared the 2015 and 2025 ATA initial risk stratification systems. The primary outcome was structural disease-free survival (SDFS). Performance was assessed using area under the receiver operating characteristic curve (AUC), reclassification analysis, and decision curve analysis (DCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 1508 patients (median age 43 years, interquartile range [IQR] = 33\u201353; 1147 [76.1%] female), 120 (8.0%) developed events during a median follow-up of 8.9 years (IQR = 7.56\u201310.80). The 2025 ATA system demonstrated superior discrimination compared with the 2015 system (\u0394AUC 0.0455 [confidence interval or CI: 0.0147\u20130.0764],\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.004), although both systems showed significant risk stratification (log-rank\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). Reclassification analysis revealed that the 2025 system reassigned 41.7% of patients with recurrence to higher-risk categories but also reassigned 38.8% of recurrence-free patients to higher-risk categories. Multivariable analyses identified the revised multifocality criteria and the presence of two or more low-to-intermediate risk features as the major contributors to this reclassification (risk inflation). Conversely, refined compartment-based lymph node stratification was associated with improved classification accuracy. DCA demonstrated greater net clinical benefit for the 2025 system across clinically relevant threshold probabilities.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The 2025 ATA initial risk stratification system significantly improves prognostic discrimination compared with the 2015 system. However, the enhanced sensitivity comes with a specificity trade-off, leading to substantial upward risk reclassification for recurrence-free patients. These real-world findings provide critical insights for clinicians to balance intensified surveillance against the potential for overtreatment under the new guidelines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10507256261494916","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:21:27Z","timestamp":1791433287000},"page":"1169-1177","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Performance of the 2015 and 2025 American Thyroid Association Initial Recurrence Risk Stratification Systems in Differentiated Thyroid Cancer"],"prefix":"10.1177","volume":"36","author":[{"given":"Weixun","family":"Ke","sequence":"first","affiliation":[{"name":"The Graduate School of Fujian Medical University, Fuzhou, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuanling","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China."},{"name":"Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liying","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China."},{"name":"Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyi","family":"Xiao","sequence":"additional","affiliation":[{"name":"The Graduate School of Fujian Medical University, Fuzhou, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjing","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Medicine, Xiamen University, Xiamen, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Jinhua People\u2019s Hospital, Jinhua, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najun","family":"Ke","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The Fifth Hospital of Xiamen, Xiamen, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peiying","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China."},{"name":"Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingbao","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruisheng","family":"Ke","sequence":"additional","affiliation":[{"name":"Department of Thyroid Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunzhai","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Thyroid Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1902-2704","authenticated-orcid":false,"given":"Fangsen","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China."},{"name":"Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China."},{"name":"Fujian Province Key Laboratory of Diabetes Translational Medicine, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)12488-9"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27025"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1210\/er.2019-00085"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2014.1"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(22)00035-3"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2009.1601"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0020"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2016.0068"},{"key":"e_1_3_2_10_1","volume-title":"AJCC Cancer Staging Manual","author":"Amin MB","year":"2017","unstructured":"9.Amin MB, , American Joint Committee on Cancer. AJCC Cancer Staging Manual. Eight edition, Springer: Chicago IL; 2017."},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/10507256251363120"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2018.11.003"},{"key":"e_1_3_2_13_1","volume-title":"Endocrine and Neuroendocrine Tumours","author":"Centre international de recherche sur le cancer, Organisation mondiale de la sant\u00e9","year":"2025","unstructured":"12.Centre international de recherche sur le cancer, Organisation mondiale de la sant\u00e9. Endocrine and Neuroendocrine Tumours. 5th ed. vol. 10. International agency for research on cancer: Lyon, France; 2025.","edition":"5"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2021.1976"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13277-015-4533-5"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2017-00277"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/lio2.824"},{"key":"e_1_3_2_18_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2018.0547"},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2020.06.015"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2020.01.049"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-023-03496-3"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/path.4696"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-018-1496-1"},{"key":"e_1_3_2_24_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2017.0334"},{"key":"e_1_3_2_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.27067"},{"key":"e_1_3_2_26_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgag167"},{"key":"e_1_3_2_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2026.107912"}],"container-title":["Thyroid\u00ae"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10507256261494916","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10507256261494916","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10507256261494916","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T08:53:19Z","timestamp":1793263999000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10507256261494916"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":26,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11,1]]}},"alternative-id":["10.1177\/10507256261494916"],"URL":"https:\/\/doi.org\/10.1177\/10507256261494916","relation":{},"ISSN":["1050-7256","1557-9077"],"issn-type":[{"value":"1050-7256","type":"print"},{"value":"1557-9077","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]}}}