Usefulness of dynamic risk stratification in pediatric patients with differentiated thyroid carcinoma

Kim, Kwangsoon; Kim, Won Woong; Choi, Jun Shik; Kim, Min Jhi; Lee, Cho Rok; Lee, Jandee; Kang, Sang–Wook; Nam, Kee Hyun; Chung, Woong Youn; Jeong, Jong Ju

doi:10.4174/astr.2018.95.4.222

Cited by 9 publications

(5 citation statements)

References 30 publications

(41 reference statements)

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“…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%

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: 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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“…In our series, this male preponderance may be explained by the higher frequency of metastases at diagnosis in males (p=0.036). The presence of nodal disease has been associated with persistent disease in other studies [ 5 , 7 ], and Pires et al [ 10 ] also found that female gender and distant metastasis were significantly associated with disease-free status. Of note, ATA risk group stratification and DRS were two other factors significantly associated with persistent disease, confirming the findings of others [ 4 ].…”

Section: Discussionmentioning

confidence: 90%

“…Around 60% of our patients with pulmonary metastases had regionally extensive disease, a finding supported by others [ 3 ], emphasizing the potential role of lymph node status at diagnosis for the prognosis. The DRS system was evaluated in pediatric patients by others [ 4 - 7 , 10 ]: Sung et al [ 7 ] found that both ATA risk stratification and DRS systems were associated with the clinical outcomes (p<0.001 for both); Zanella et al [ 4 ] showed that DRS was an excellent tool for predicting clinical outcomes in their cohort of sixty-six patients, in which the majority remained in the same category they had in DRS; Kim et al [ 5 ] (128 patients) compared ATA risk stratification and DRS system and demonstrated the superiority of the latter in predicting disease outcomes, similarly to Adjari et al [ 10 ] and Lazar et al [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Tuttle et al [3] designed the Dynamic Risk Stratification (DRS) system, where the risk of recurrent/persistent disease in patients with DTC was reassessed during follow-up according to the response to initial therapy, determined by clinical, biochemical, and imaging data. This system was validated only for the adult population with DTC, although some studies investigate its use in children [4][5][6][7]. Our aims were to access the performance of the DRS system in the pediatric population followed in our centre and to evaluate potential clinical-pathological factors associated with persistent disease.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Differentiated Thyroid Cancer in a Pediatric Population: Estimating the Risk of Recurrence and Evolution Over Time

Damasio¹,

Dias²,

Pinheiro³

et al. 2023

Cureus

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BackgroundDifferentiated thyroid cancer (DTC) is the most common endocrine cancer during childhood, and the prognosis is usually good. The 2015 American Thyroid Association (ATA) pediatric guidelines for DTC classify patients into three categories (low, intermediate, and high) that represent the risk for persistent/recurrent disease. The "Dynamic Risk Stratification" (DRS) System showed that, in adults, reassessment of disease status during follow-up was a better predictor of disease status at the end of followup when compared to ATA risk stratification. This system is still not validated for the pediatric population with DTC. Our aim was to evaluate the usefulness of the DRS system in predicting DTC disease behaviour in this specific population. We also aimed to evaluate potential clinical-pathological factors associated with persistent disease at the end of follow-up. MethodsA retrospective analysis of 39 pediatric patients (≤18 years) with DTC was conducted in our institution between 2007 and 2018, including 33 patients who had follow-up ≥ 12 months; these were classified into ATA risk groups and re-stratified according to their response to treatment at 12-24 months of follow-up. The associations between the ordinal variables of the baseline ATA risk group and the disease status re-evaluated 12-24 months after diagnosis (as per the DRS system) and at the end of follow-up were evaluated using a linear-by-linear association test. Gender, age at diagnosis, tumor size, multicentricity, extrathyroid extension, vascular invasion, lymph node metastasis, distant metastasis, and stimulated thyroglobulin (sTg) during the first RAI administration were evaluated as potential factors associated with persistent disease at 27 months after diagnosis using Firth's bias-reduced penalized-likelihood logistic regression. ResultsIn this study, 39 patients were retrospectively analyzed, including 33 patients who had follow-ups ≥ 12 months with a median time of 56 (27-139) months who were classified in ATA risk groups and then restratified depending on their response to treatment between 12 and 24 months of follow-up. There was a statistically significant association between ATA risk groups and re-evaluation at 12 and 24 months (p=0.001) and between these two stratifications and the state of disease at final follow-up (p<0.001 for both). Factors with a statistically significant association with persistent disease at 27 months of follow-up were male sex, lymph node metastases at diagnosis, distant metastasis, extrathyroidal extension, and stimulated Tg values. ConclusionsThe assessment of the response to treatment between 12 and 24 months and at the end of follow-up refines the initial ATA risk stratification, confirming that dynamic risk evaluation is also helpful in the pediatric population.

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“… 28 30 31 32 33 34 Kim et al applied the adults DRS system in their pediatric DTC population and concluded that DRS from 1 to 2 years after diagnosis can provide useful prognostic information along with ATA risk stratification in pediatric patients with DTC. 35 Considering these observations, we assessed the response after 1.5 years of diagnosis by taking a cutoff value of 10 ng/dL (stimulated) and 1 ng/dL (unstimulated) for classifying “responders” and “incomplete responders.”…”

Section: Dynamic Risk Stratification By Response To Treatment Reclass...mentioning

confidence: 99%

Applicability of Adults 2015 American Thyroid Association Differentiated Thyroid Cancer Guidelines for Postoperative Risk Stratification and Postradioiodine Treatment Dynamic Risk Stratification in Pediatric Population

et al. 2022

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Purpose This retrospective study aimed to study the applicability of 2015 adult American Thyroid Association (ATA) differentiated thyroid cancer (DTC) postoperative risk stratification and guidelines in the pediatric population for evaluating the number of metastatic lymph nodes in the postoperative risk stratification and postradioactive iodine (RAI) treatment dynamic risk stratification (DRS) using response to treatment (RTT) reclassification. In addition, the effect of pubertal status and gender was assessed on disease presentation and prognosis. Methods Data of 63 DTC patients aged 20 years or less, stratified into prepubertal, pubertal, and postpubertal age groups, was divided into low, intermediate, and high-risk groups using pediatric ATA recurrence risk stratification. Forty-seven patients were classified as responders (excellent and indeterminate responses) and incomplete responders (biochemical and structurally incomplete responses) by assessing the RTT at 1.5 years follow-up similar to recommendation of 2015 adult DTC ATA guidelines. Results Female-to-male ratio showed a trend of gradual increase with increasing age. Significantly more responders were observed in low- and intermediate-risk groups than in high-risk group (p = 0.0013; p = 0.017, respectively), while prepubertal group had more extensive (N1b) disease. Using DRS at follow-up of 1.5 year, pubertal and postpubertal groups showed significantly better response to RAI. More female than male patients showed response and took significantly less time to respond to RAI (p = 0.003). Conclusion RAI response in pediatric DTC depends on pubertal status, gender, and number of malignant nodes. DRS using RTT classification may be applicable early at 1.5 years after initial therapy in different pubertal age and risk groups.

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Usefulness of dynamic risk stratification in pediatric patients with differentiated thyroid carcinoma

Cited by 9 publications

References 30 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

Differentiated Thyroid Cancer in a Pediatric Population: Estimating the Risk of Recurrence and Evolution Over Time

Applicability of Adults 2015 American Thyroid Association Differentiated Thyroid Cancer Guidelines for Postoperative Risk Stratification and Postradioiodine Treatment Dynamic Risk Stratification in Pediatric Population

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