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

Abstract

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.

Tumor size is an independent negative prognostic factor for event free survival in children with differentiated thyroid cancer

“…In this cohort, pediatric DTC had a high incidence of LNM and distant metastasis (70.5% and 13.6%, respectively) as well as high rate of events (10 years EFS of 79.2%). This is consistent with several previous studies ( 8 , 12 , 22 – 25 ). Despite the presence of advanced disease in children with DTC in this cohort, long-term prognosis was excellent and 10 years overall survival was 98.4%, which is also in line with previous reports on pediatric DTC from different ethnicities ( 8 , 13 , 24 , 26 , 27 ).…”

“…There are several reports where large tumor size and initial distant metastasis are found to have adverse impact on the recurrence and prognosis of pediatric DTC ( 14 , 24 , 28 , 29 ). Although several other factors have been previously reported to be negatively associated with EFS, such as age, extent of resection and serum thyroglobulin levels ( 8 , 25 , 30 ), in our study, age, ATA risk stratification and other clinico-pathological parameters (extrathyroidal extension, bilaterality, multifocality, lymphovascular invasion and response to therapy) were not independent risk factors for EFS.…”

Retrospective analysis of clinical characteristics and risk factors of differentiated thyroid cancer in children

“…An analysis conducted by Al-Qahtani et al in children and adolescents with DTC under 18 years old has indicated that young age was dramatically related to the recurrence in situ ( 14 ). Domestic studies have compared specificity and difference in clinical characteristics of DTC between preadolescent children and adolescents; the incidence of distant metastases was reported to be higher in those of young age ( 16 ). This study first provides insights into the clinical features in DTC children younger than or equal to 13 years of age.…”

Predictive Values of Inflammation-Related Markers and Thyroid Function in Pediatric Thyroid Cancer Patients

“…However, the malignancy rate is 1/4, which is significantly higher than that in adults (2). The main bias of guidelines is the lack of detailed data and research, despite the particularity of the treatment and the fact that prognosis of pediatric differentiated TC patients have been clarified (14). Hence, further studies on pediatric TC remain to be investigated.…”