Recurrent Disease in Juvenile Differentiated Thyroid Carcinoma: Prognostic Factors, Treatments, and Outcomes

Abstract

The overall prognosis in pediatric differentiated thyroid carcinoma (DTC) is excellent. Recurrent disease is frequent, however, and requires additional treatment. We analyzed the probability of recurrence, prognostic factors, treatment, and outcome of juvenile DTC. Methods: Fifty-one DTC patients (32 girls and 19 boys; ≤20 y old; mean age, 16.5 y) were treated with 131 I (radioiodine, or radioactive iodine [RAI]); the median follow-up was 10 y. Patients underwent different initial treatments: 46 patients received total thyroidectomy and RAI, 3 patients received total thyroidectomy, and 3 patients received subtotal thyroidectomy. The probability of recurrence and prognostic factors were tested with the Kaplan-Meier method. Results: Initially, 36 of 51 patients achieved complete remission, 14 of 51 achieved partial remission, and 1 of 51 had progressive disease. By the follow-up, 11 of 51 patients (21.6%) had developed recurrent disease; the median appearance time was 4 y (range, 1-15 y). The probabilities of recurrence were 16.7% at 5 y, 22.3% at 10 y, and 33.3% at 15 and 23 y after the initial treatments. Factors that were strongly predictive of recurrence were age (P 5 0.001), initial treatment (P 5 0.0001), and tumor multifocality (P 5 0.011). Sex, nodal metastases at presentation, distal metastases at presentation, histologic type of the tumor, T stage, and clinical stage had no influence on relapse (P 5 0.180, P 5 0.786, P 5 0.796, P 5 0.944, P 5 0.352, and P 5 0.729, respectively). Patients with recurrent disease, partial remission, and progressive disease were retreated, with either surgery or surgery and RAI, receiving cumulative activities of up to 40 GBq. The overall outcome in our patients was excellent: 90.2% complete remission, 3.92% partial remission, 1.96% stable disease, 1.96% disease-related death, and 1.96% another cause of death. Conclusion: Younger age at diagnosis, less radical primary surgery without subsequent RAI, and tumor multifocality are factors that are strongly prognostic for recurrence. For reducing the rate of relapse and improving surveillance for recurrent disease, total thyroidectomy followed by RAI appears to be the most beneficial initial treatment for patients with juvenile DTC. The use of RAI seems to be safe, with no adverse effects on subsequent fertility and pregnancy or secondary malignancy.

Radioactive iodine (RAI) therapy for distantly metastatic differentiated thyroid cancer (DTC) in juvenile <i>versus</i> adult patients

“…In our present series, there was a 1.5% (23/1552) incidence of juvenile DTC, and 17.4% (4/23) of those patients developed recurrent disease. These data are in agreement with the previously reported recurrence rates (11-32%) [1,15].…”

“…In the absence of exposure to external radiation, thyroid cancer is rather infrequent (2-10%) in patients 20 years old or younger [1,13,14,15]. In our present series, there was a 1.5% (23/1552) incidence of juvenile DTC, and 17.4% (4/23) of those patients developed recurrent disease.…”

“…Twenty (87.0%) of these patients had PTC and 3 (13.0%) had FTC. Six of the 20 PTC patients initially underwent in tumor size, the number of sites, or the Tg level) [1].…”

“…Patients were classified as having complete remission (CR) (no evidence of disease), partial remission (PR) (decrease in the number of sites or intensity of radioiodine uptake on 131 I WBS combined with a decrease in the Tg level), recurrent disease (appearance of disease in any patient who had been disease-free for at least 4 months), progressive disease (PD) (elevation of the Tg level or an increase in lesion size or the number of sites), or stable disease (SD) (no apparent change in tumor size, the number of sites, or the Tg level) [1]. near-total or total thyroidectomy with modified neck lateral lymph-node resection (MNLNR), 9 underwent subtotal thyroidectomy with MNLNR, 5 underwent hemi-thyroidectomy with MNLNR or central lymph node resection (CLNR), and the 3 with FTC underwent hemi-thyroidectomy.…”

“…In terms of histological type, based on investigations by our institution since 1993, the incidence of papillary carcinoma has been 92.0%, that of follicular carcinoma 5.9%, that of medullary carcinoma 1.0%, and that of anaplastic carcinoma 1.2%. DTC in childhood shows aggressive clinical onset; 60-80% of patients have cervical nodal involvement, often associated with distant metastasis but without overall higher mortality compared with that in adults [1,[5][6][7][8]. However, the risk of cancer relapse is high, with more frequent local recurrence than in adults.…”