Discussion
cancer
RECURRENCE, CANCER, RECURRENCE
The application value of the 2015 ATA risk stratification in initial treatment patients has been well substantiated, and some studies have confirmed the relevant risk factors for patients with re-recurrence (In this study, initial treatment was the most important predictive factor for recurrence. Recurrence in patients often results in a referral to a higher-level hospital for further treatment, leading to incomplete patient information and exclusion from retrospective studies (Some studies have indicated that the prognostic significance of ENE and LNR have been identified as adverse prognostic factors in previous studies (The proposed predictive model exhibits the ability to accurately prognosticate based on existing patient characteristics, thereby surpassing the limitations of conventional research. Moreover, this model highlighted the risk of relapse among non-initial treatment patients, potentially attributable to comprehensive pathological and socioenvironmental factors. Thus, clinicians should reassess their optimistic stance on the favorable prognosis of PTC in non-primary cases, necessitating a more proactive and cautious approach for the diagnosis and management of such patients.This study has some limitations. First, all enrolled patients were recruited from the same cancer center without external validation. Moreover, we need to expand the sample size to reduce heterogeneity. In addition, the data were collected retrospectively and remained open to an unknown selection bias. Furthermore, some important risk variables, such as the LNM dimensions were not assessed in this study. Finally, the follow-up time may be too short, as some patients with a low recurrence risk may manifest clinically significant recurrence many years after treatment.