Performance of the American Thyroid Association Risk Classification in a Single Center Cohort of Pediatric Patients with Differentiated Thyroid Cancer: A Retrospective Study

Abstract

Introduction. Differentiated thyroid cancer (DTC) is the most common endocrine malignancy in children. Retrospective studies show conflicting results regarding predictors of persistent and recurrent disease after initial therapy. In 2015, the American Thyroid Association (ATA) proposed a clinical classification system to identify pediatric thyroid cancer patients at risk for persistent/recurrent disease. Material and Methods. We retrospectively included all patients in our registry diagnosed with papillary DTC at ≤ 18 years of age. We analyzed the prognostic performance of the ATA classification and other risk factors for predicting response to initial treatment and final outcome in pediatric DTC. Results. We included 41 patients, 34 females and 7 males, diagnosed with papillary DTC at a mean (SD) age of 16.2 (1.8) years. Based on the ATA pediatric risk classification, patients were categorized as low (61%), intermediate (10%), or high risk (29%). The median follow-up period was 7.3 (1-41) years. After initial treatment, disease free status was achieved in 92%, 50%, and 42% of the low, intermediate, and high risk groups, respectively (P <0.01). At the last visit, persistent disease was present in 12%, 25%, and 33% (P=0.27). Assessing other risk factors, only the presence of distant metastases at diagnosis resulted in increased presence of persistent disease at last follow-up (P=0.03). Conclusion. This study supports the clinical relevance of the ATA risk classification for predicting the response to initial treatment. There was no clear prediction of long-term outcome, but this may be due to limited power caused by the small number of patients.

Differentiated Thyroid Cancer in Children and Adolescents: Long Term Outcome and Risk Factors for Persistent Disease

“…Therefore, follow-up might be less intensive for these patients. In two previous publications, the risk of recurrence of the patients in ER was higher (13-30%) [26,32], and this difference is possibly due to different methods used to classify patients in ER. The probability of achieving ER after initial treatment depended on risk category (from 80% in low-risk to only 15.5% in high-risk patients).…”

Which is preferred for initial treatment of papillary thyroid cancer, total thyroidectomy or lobotomy?

“…Total thyroidectomy and lobectomy remain the main primary surgical interventions for thyroid carcinoma. To date, there has been no large sample randomized controlled clinical trial to compare these two methods, hence their relative efficacy remains controversial and comparative studies have relied mainly on retrospective analyses 2 . This indicates that, although the progress of papillary thyroid carcinoma (PTC) is slow, the ability and tendency to metastasize to lymph nodes and even distant organs are consistent with other malignancies.…”

Papillary Thyroid Carcinoma in Children: Clinicopathological Profile and Outcomes of Management

“…There is a paucity of the literature with regard to rates of persistent disease in children following treatment for well‐differentiated thyroid cancers. Alwithenani et al reported persistent disease in 27% of children 1 year following treatment for papillary carcinoma thyroid which reduced to 7.3% at 4 years [40]. In another study, 35% had persistent disease two years following treatment which dropped to 21.6% at last follow‐up [41].…”