Pires Barbara Pereira, Alves Paulo Alonso Garcia, Bordallo Maria Alice, Bulzico Daniel Alves, Lopes Flavia Paiva Proença Lobo, Farias Terence, Dias Fernando, Lima Roberto Araújo, Santos Gisler Izabella Costa, Coeli Claudia Medina, Carvalhaes de Oliveira Raquel Vasconcellos, Corbo Rossana, Vaisman Mario, Vaisman Fernanda
1 Endocrinology Department, Universidade Federal do Rio de Janeiro , Rio de Janeiro, Brazil .
2 Endocrinology Department, Instituto Nacional do Cancer do Rio de Janeiro , Rio de Janeiro, Brazil .
Thyroid. 2016 Oct;26(10):1480-1487. doi: 10.1089/thy.2016.0302. Epub 2016 Sep 22.
The incidence of pediatric differentiated thyroid carcinoma (DTC) has been rising in recent years, and the main risk factors for recurrence are lymph node and distant metastasis at diagnosis. Other clinical features remain unclear, such as the impact of age, sex, and puberty. Furthermore, until now, this population has been treated using the same strategies used to treat adults. In 2015, the American Thyroid Association (ATA) published the first guidelines targeted at this age group. The aims of this study were to investigate the prognostic factors for early and long-term remission and also to validate the ATA risk stratification proposal in a population outside the United States.
Clinical records from 118 patients <18 years old followed in two referral centers were reviewed. The median age was 12 years (range 4-18 years), and 20.3% (24 patients) were <10 years old at diagnosis. The median follow-up was 9.1 years. The majority were female (72%) and received total thyroidectomy and radioiodine therapy (RAI), and 61.8% were treated with more than one dose of RAI. The majority were classified as high risk (48.3%) by the new ATA pediatric guidelines due to distant metastasis (30 patients) or extensive lymph node involvement (27 patients). The remained were classified as low risk (31.3%) and intermediate risk (20.4%).
Females with no lymph node or distant metastasis and low ATA pediatric risk were more likely to have no evidence of disease (p < 0.05) within the first year and also in the long term. In this study, age did not significantly predict outcomes. Furthermore, patients also benefitted from multiple doses of RAI, but when the cumulative activity was >400 mCi, this benefit was diminished.
This study shows that the ATA risk stratification proposal for pediatric patients is useful in predicting early and long-term outcomes in pediatric patients with DTC. In addition, it shows that sex and metastatic disease are important prognostic factors in pediatric populations.
近年来，儿童分化型甲状腺癌（DTC）的发病率一直在上升，复发的主要危险因素是诊断时的淋巴结和远处转移。其他临床特征仍不明确，如年龄、性别和青春期的影响。此外，到目前为止，该人群一直采用与成人相同的治疗策略。2015年，美国甲状腺协会（ATA）发布了首个针对该年龄组的指南。本研究的目的是调查早期和长期缓解的预后因素，并在美国以外的人群中验证ATA风险分层建议。
回顾了两个转诊中心随访的118例18岁以下患者的临床记录。中位年龄为12岁（范围4-18岁），20.3%（24例患者）诊断时年龄小于10岁。中位随访时间为9.1年。大多数为女性（72%），接受了全甲状腺切除术和放射性碘治疗（RAI），61.8%接受了一剂以上的RAI治疗。根据新的ATA儿童指南，由于远处转移（30例患者）或广泛的淋巴结受累（27例患者），大多数被归类为高风险（48.3%）。其余患者被归类为低风险（31.3%）和中风险（20.4%）。
无淋巴结或远处转移且ATA儿童风险低的女性在第一年及长期更有可能无疾病证据（p<0.05）。在本研究中，年龄并未显著预测预后。此外，患者也从多剂量的RAI中获益，但当累积活度>400mCi时，这种获益会减弱。
本研究表明，ATA儿童患者风险分层建议有助于预测儿童DTC患者的早期和长期预后。此外，研究表明性别和转移性疾病是儿童人群重要的预后因素。
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