Thyroid Section, Endocrine Division, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul , Porto Alegre, Brazil .
Thyroid. 2017 Jun;27(6):787-792. doi: 10.1089/thy.2016.0559. Epub 2017 Apr 12.
Prognostic factors are essential for risk stratification in patients with differentiated thyroid carcinoma (DTC). The role of stimulated postoperative thyroglobulin (sPOTg) has been well established in adult DTC population, but it remains unclear in children and adolescents. This study aimed to evaluate potential prognostic factors in children and adolescents with DTC, with special emphasis on sPOTg analysis.
Individuals aged ≤18 years at diagnosis were selected from a cohort of DTC patients attending the thyroid clinic of a tertiary university-based hospital. Baseline clinical and oncological characteristics, interventions, disease status, and outcomes were obtained from medical records. Clinical variables included in the univariate analysis were sex, age at diagnosis, tumor size, the presence of lymph node and distant metastasis, and sPOTg. Additionally, sPOTg was evaluated using the area under the receiver operating characteristic curve analysis.
Thirty-two children and adolescents with DTC (28 girls, 87.5%; the mean age at diagnosis = 14.7 ± 3.2 years) were included in this study. Thirty-one (96.9%) patients had papillary thyroid carcinoma. The median tumor size was 2.0 cm (P25-75 = 1.6-3.5), 22 patients (68.8%) had lymph node disease, and 5 (15.6%) had distant metastasis at diagnosis. All patients underwent total thyroidectomy, and 29 (90.6%) received radioactive iodine therapy. After a median follow-up of 5.0 years (P25-75 = 2.0-10.0), disease status was available for 27 patients: 15 (55.6%) patients were disease free, six (22.5%) had biochemical disease, and six (22.2%) had persistent structural disease (two cervical and four distant metastasis). Prognostic factors associated with persistent disease in the univariate analysis were lymph node and distant metastasis at diagnosis and sPOTg. According to the receiver operating curve analysis (n = 17 patients), the best sPOTg cutoff to predict disease-free status was 31.5 ng/mL, with a sensitivity and specificity of 100%.
The data demonstrate that sPOTg displayed high accuracy in predicting the risk of persistent disease in young patients with DTC.
对于分化型甲状腺癌（DTC）患者，预后因素对于风险分层至关重要。刺激后甲状腺球蛋白（sPOTg）在成年 DTC 人群中的作用已得到充分证实，但在儿童和青少年中仍不清楚。本研究旨在评估 DTC 患儿中潜在的预后因素，特别强调 sPOTg 分析。
从一家三级大学附属医院的甲状腺诊所就诊的 DTC 患者队列中选择诊断时年龄≤18 岁的个体。从病历中获取基线临床和肿瘤特征、干预措施、疾病状态和结局。单因素分析中包括的临床变量包括性别、诊断时的年龄、肿瘤大小、淋巴结和远处转移的存在以及 sPOTg。此外，还使用接受者操作特征曲线分析评估 sPOTg。
本研究纳入了 32 名患有 DTC 的儿童和青少年（28 名女孩，87.5%；诊断时的平均年龄为 14.7±3.2 岁）。31 名（96.9%）患者患有甲状腺乳头状癌。肿瘤大小中位数为 2.0cm（P25-75=1.6-3.5），22 名（68.8%）患者有淋巴结疾病，5 名（15.6%）患者在诊断时发生远处转移。所有患者均接受了全甲状腺切除术，29 名（90.6%）患者接受了放射性碘治疗。在中位随访 5.0 年后（P25-75=2.0-10.0），27 名患者的疾病状态可评估：15 名（55.6%）患者无疾病，6 名（22.5%）患者有生化疾病，6 名（22.2%）患者有持续结构性疾病（2 名颈部和 4 名远处转移）。单因素分析中与持续性疾病相关的预后因素是诊断时的淋巴结和远处转移以及 sPOTg。根据接收者操作曲线分析（n=17 名患者），预测无疾病状态的最佳 sPOTg 截止值为 31.5ng/mL，敏感性和特异性均为 100%。
数据表明，sPOTg 在预测年轻 DTC 患者持续性疾病的风险方面具有很高的准确性。
