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Comparison of 2015 and 2025 ATA Risk Stratification Systems for Predicting Recurrence in Papillary Thyroid Carcinoma
Ji Hyun Yoo1, Sungjoo Lee2, Bo Ram Kim3
1Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Annals of Surgical Oncology
|August 8, 2026
Summary
The 2025 American Thyroid Association (ATA) guidelines offer a new risk system for papillary thyroid cancer (PTC) that effectively identifies high-risk patients. This updated system shows comparable performance to the previous one in predicting PTC recurrence.
Area of Science:
- Endocrinology
- Oncology
- Surgical Oncology
Background:
- The 2025 American Thyroid Association (ATA) guidelines introduced a revised risk stratification system for thyroid cancer.
- This new system incorporates histology-specific models and a four-tier classification framework.
- Its clinical performance in patients with papillary thyroid carcinoma (PTC) requires validation.
Purpose of the Study:
- To compare the 2015 and 2025 ATA risk stratification systems for predicting PTC recurrence.
- To evaluate reclassification patterns under the new system.
- To assess the clinical utility of the 2025 ATA system in managing PTC.
Main Methods:
- Retrospective cohort study of 284 PTC patients undergoing surgery (2019-2021).
- Risk classification using the 2015 ATA three-tier and 2025 ATA four-tier systems.
- Predictive performance assessed via disease-free survival (DFS) and integrated area under the receiver operating characteristic curve (iAUC).
Main Results:
- Recurrence occurred in 8.1% of patients.
- The 2025 system concentrated recurrence events in the high-risk group (20/89 patients).
- The 2025 system led to significant reclassification, especially for intermediate-risk patients, with comparable iAUC values to the 2015 system.
Conclusions:
- The 2025 ATA risk stratification system shows predictive performance comparable to the 2015 system.
- The new system improves risk discrimination by concentrating recurrence events in the high-risk group for PTC.
- This suggests enhanced clinical utility for managing PTC patients.