Sung Tae Yon, Jeon Min Ji, Lee Yi Ho, Lee Yu-Mi, Kwon Hyemi, Yoon Jong Ho, Chung Ki-Wook, Kim Won Gu, Song Dong Eun, Hong Suck Joon
Department of Surgery.
Department of Internal Medicine, and.
J Clin Endocrinol Metab. 2017 Mar 1;102(3):793-800. doi: 10.1210/jc.2016-2666.
The objective of this study was to evaluate the usefulness of American Thyroid Association (ATA) risk classification and dynamic risk stratification (DRS) based on the response to initial therapy in pediatric patients with differentiated thyroid cancer (DTC).
This historical cohort study included 77 pediatric patients with DTC who underwent thyroid surgery. Clinical outcomes during median 5.3 years of follow up were assessed according to 3 ATA risk groups and 4 DRS groups.
In ATA risk classification, 22%, 48%, and 30% of patients were in the low-, intermediate-, and high-risk groups, respectively. There was no significant difference in disease-free survival (DFS) between the indeterminate and the low-risk group. The risk of recurrent/persistent disease was significantly higher only in the high risk group [hazard ratio (HR), 18.4; P = 0.005]. In DRS, 49%, 13%, 6%, and 31% of patients were classified in the excellent, indeterminate, biochemical incomplete, and structural incomplete response groups, respectively. The risk of recurrent/persistent disease was significantly higher in the indeterminate group (HR, 10.2; P = 0.045) and in the structural incomplete group (HR, 98.7; P = 0.005) compared with the excellent response group.
DRS based on the response to initial therapy could be useful in addition to initial ATA pediatric risk classification to predict recurrent/persistent disease in pediatric patients with DTC.
本研究的目的是评估美国甲状腺协会（ATA）风险分类以及基于分化型甲状腺癌（DTC）儿科患者初始治疗反应的动态风险分层（DRS）的有用性。
这项历史性队列研究纳入了77例接受甲状腺手术的DTC儿科患者。根据3个ATA风险组和4个DRS组评估了中位随访5.3年期间的临床结局。
在ATA风险分类中，分别有22%、48%和30%的患者属于低、中、高风险组。不确定组和低风险组之间的无病生存率（DFS）无显著差异。仅高风险组复发/持续性疾病的风险显著更高[风险比（HR），18.4；P = 0.005]。在DRS中，分别有49%、13%、
