Long-term outcome of differentiated thyroid cancer in children and young adults: risk stratification by ATA criteria and assessment of pre-ablation stimulated thyroglobulin as predictors of disease persistence

Karapanou, Olga; Tzanela, Marinella; Rondogianni, Phoebe; Dacou-Voutetakis, Catherine; Chiotis, Dimitrios; Vlassopoulou, Barbara; Vassiliadi, Dimitra Argyro; Kanaka‐Gantenbein, Christina; Tsagarakis, Stylianos

doi:10.1007/s12020-020-02378-2

Cited by 23 publications

(14 citation statements)

References 40 publications

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“…Tg is a specific and sensitive protein used as marker for the presence of follicular thyroid cells, and serum Tg measurement is a cornerstone tool in the management of DTC patients and is reasoned as the most sensitive method to detect persistent or recurrent disease. Few studies demonstrated the usefulness of sTg as prognostic factor in small and heterogeneous DTC pediatric populations and/or mixed with adults [12,14,16,21,30] and suggested various sTg cutoff values ranging from 10 to 37.8 ng/ml. This wide interval is directly related to the patients features recruited.…”

Section: Discussionmentioning

confidence: 99%

“…Instead, the role of sTg in DTC pediatric patients remains to be fully established [12][13][14][15]. At the same time, the usefulness of ATA risk classification in children with DTC has been evaluated in few studies [16][17][18][19][20][21], and also the 1-year response to initial therapy categories presented in the 2015 adults' guideline (i.e., excellent response, biochemical incomplete response, structural incomplete response and indeterminate response) [3] has been tested few cases of pediatric population.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic factors in children and adolescents with differentiated thyroid carcinoma treated with total thyroidectomy and RAI: a real-life multicentric study

Cistaro

Quartuccio

Garganese

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose This multicentric study aimed to investigate the main prognostic factors associated with treatment response at 1 year after radioactive iodine therapy (RAIT) and the last disease status in pediatric patients affected by differentiated thyroid carcinoma (DTC). Materials and methods In the period 1990–2020, all consecutive patients ≤ 18 years from six different centers were retrospectively included. Patients were classified as low, intermediate, and high risk for persistence/recurrence. The response to RAIT was evaluated and scored 1 year later according to 2015 ATA guidelines. Moreover, at the last follow-up, the disease status was evaluated and dichotomized as no evidence of disease (NED) or persistent disease. Results Two hundred and eighty-five patients (197 female, 88 male; mean age 14.4 years) were recruited. All, except nine, underwent near-total thyroidectomy followed by RAIT. One-year after first RAIT, 146/276 (53%) patients had excellent response, 37/276 (14%) indeterminate response, and 91/276 (33%) incomplete response. One-year after RAIT, children with excellent response had significantly lower stimulated thyroglobulin (sTg) compared to not excellent group (median sTg 4.4 ng/ml vs 52.5 ng/ml, p < 0.001). ROC curve showed sTg higher than 27.2 ng/ml as the most accurate to predict 1-year treatment response. After a median follow-up of 133 months, NED was present in 241 cases (87%) while persistent disease in 35 (13%). At multivariate analysis, sTg and 1-year treatment response categories were both significantly associated with the last disease status (p value 0.023 and < 0.001). Conclusions In pediatric DTC, sTg is significantly associated with 1-year treatment response and final outcome. However, 1-year response is the principal prognostic factor able to predict pediatric DTCs outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic factors in children and adolescents with differentiated thyroid carcinoma treated with total thyroidectomy and RAI: a real-life multicentric study

Cistaro

Quartuccio

Garganese

et al. 2021

Eur J Nucl Med Mol Imaging

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“…Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer in children and adolescents, which accounts for 90% (3,4). Although the prognosis of pediatric patients with PTC is excellent and the mortality rate is low, they have higher rates of cervical lymph node metastases (LNMs), extrathyroidal extension (ETE), distant metastasis, and recurrence than the adults (5)(6)(7)(8). Furthermore, a second operation for relapsed patients has a great impact on the quality of life of children and adolescents with PTC.…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors for Recurrence of Papillary Thyroid Carcinoma in Children and Adolescents

et al. 2022

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BackgroundThe incidence of papillary thyroid carcinoma (PTC) in children and adolescents has increased, but the data on long-term outcomes are limited. There are few literatures on the clinicopathological characteristics and prognosis of PTC in children and adolescents in China. Therefore, it is necessary to identify clinicopathological features to precisely predict clinical prognosis and to help choose the optimal method and perform the best therapeutic regimen.MethodsThis study was a retrospective analysis of patients undergoing thyroidectomy at Tianjin Medical University Cancer Institute and Hospital. We analyzed the factors related to the clinicopathological features and prognosis of PTC in children and adolescents.ResultsA total of 95 juvenile PTC patients who underwent thyroidectomy were enrolled. Our research found that patients with younger age (<14 years) were predominantly multifocal and have positive preoperative thyroglobulin (Tg) and higher recurrence rate, and their number of lymph node metastases (LNMs) was more than that of the older group (14–18 years). Maximal tumor size >2 cm, T stage, and multifocality were the risk factors for LNM and the number of LNM (p < 0.05). Multivariate analysis displayed the number of central LNM as the independent risk factor for lateral LNM, and multifocality was the independent risk factor for the number of central and lateral LNM. Younger age at diagnosis, positive preoperative thyroid-stimulating hormone (TSH), maximal tumor size >2 cm, lateral LNM, number of LNM, N staging, and American Thyroid Association (ATA) pediatric risk were related to poor prognosis in PTC patients (p < 0.05). Cox regression analysis found that younger age at diagnosis and positive preoperative TSH were independent risk factors for recurrence of PTC in children and adolescents.ConclusionsOur study showed that the clinicopathological characteristics of younger age compared with older age were as follows: highly aggressive, prone to metastases, and higher recurrence rate. In our opinion, patients with characteristics such as younger age at diagnosis, positive preoperative TSH, maximal tumor size >2 cm, lateral LNM, and number of LNM >5 may be considered for prophylactic or therapeutic dissection of additional metastatic LNs by high-volume surgeons to prevent and reduce the recurrence rate of patients during long-term follow-up.

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“…In our practice, we obtain diagnostic WBSs prior to RAI in most patients under 18 years of age. If the postoperative sTg and anti-Tg levels are normal, and the WBS does not show any lung disease, it is our practice to defer chest CT. Data about the use of Tg, sTg, and anti-Tg as biomarkers continues to evolve in the population of children and young adults, though cutoffs in the literature have been variable (3,4). Similar to the authors' description of a CT-negative, WBS-positive patient, it has been our experience that chest CT can be negative in the setting of positive nuclear imaging.…”

Section: Commentarymentioning

confidence: 70%

Understanding of Pulmonary Metastases in Pediatric Patients with Differentiated Thyroid Cancer Is Evolving

Meister

Orloff

2021

Clinical Thyroidology

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BackgroundLung metastases present more commonly and with better survival rates in children and young adults than in older adults with differentiated thyroid cancer (DTC). However, given the fairly low incidence of pediatric thyroid cancer, there is a paucity of literature about the clinical considerations among children and young adults with lung metastases. This retrospective study was performed to illustrate clinical considerations of lung metastases among children and young adults including associated factors, clinical presentation, and responses to therapy (1).

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Long-term outcome of differentiated thyroid cancer in children and young adults: risk stratification by ATA criteria and assessment of pre-ablation stimulated thyroglobulin as predictors of disease persistence

Cited by 23 publications

References 40 publications

Prognostic factors in children and adolescents with differentiated thyroid carcinoma treated with total thyroidectomy and RAI: a real-life multicentric study

Prognostic factors in children and adolescents with differentiated thyroid carcinoma treated with total thyroidectomy and RAI: a real-life multicentric study

Predictive Factors for Recurrence of Papillary Thyroid Carcinoma in Children and Adolescents

Understanding of Pulmonary Metastases in Pediatric Patients with Differentiated Thyroid Cancer Is Evolving

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