儿童和青少年分化型甲状腺癌随访中的动态风险分层。
Dynamic Risk Stratification in the Follow-Up of Children and Adolescents with Differentiated Thyroid Cancer.
机构信息
1 Thyroid Unit, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul , Porto Alegre, Brazil .
2 Endocrine Division, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil .
出版信息
Thyroid. 2018 Oct;28(10):1285-1292. doi: 10.1089/thy.2018.0075.
BACKGROUND
Risk stratification for persistent disease is an important step in pediatric differentiated thyroid cancer (DTC) management. The dynamic risk stratification (DRS) is a well validated system for adults, but not yet for children and adolescents. This study evaluated the DRS as well as other prognostic factors in pediatric DTC.
METHODS
Patients aged ≤18 years from four DTC tertiary teaching hospitals in Southern Brazil were included. Clinical characteristics were systematically retrieved, and all patients were classified according to the risk-stratification system of the 2015 American Thyroid Association pediatric DTC guidelines (ATA risk) and according to DRS (excellent, indeterminate, biochemical, or structural incomplete responses). Disease status was evaluated after initial therapy and at last follow-up visit.
RESULTS
Sixty-six patients aged 14.5 ± 3.0 years were studied of whom 54 (81.8%) were girls and 62 (93.9%) had papillary thyroid carcinomas. Tumor size was 2.3 cm (P25-75 1.6-3.5); 41 (63.1%) had cervical and 18 (27.7%) distant metastasis at diagnosis. All patients underwent total thyroidectomy, and 63 (95.5%) received radioiodine. Patients were classified according to DRS after initial therapy (n = 63) as follows: 21 (33%) excellent, 13 (21%) indeterminate, 6 (9%) biochemical, and 23 (37%) structural incomplete responses. Notably, after six years (P25-75 2.7-10.0), most patients remained in the same category. Interestingly, the cutoff analysis of stimulated postoperative thyroglobulin (sPOTg) through receiver operating characteristic curve showed that the value of 37.8 ng/mL showed 81% sensitivity and 100% specificity to predict an excellent response. Prognostic factors associated with persistent disease in the univariate analysis were TNM, ATA risk, DRS, and sPOTg.
CONCLUSION
DRS after initial therapy and sPOTg are strong predictors of disease outcome and might be helpful for defining follow-up strategies in pediatric DTC.
背景
持续性疾病的风险分层是小儿分化型甲状腺癌（DTC）管理的重要步骤。动态风险分层（DRS）是一种经过充分验证的成人系统，但尚未在儿童和青少年中得到验证。本研究评估了 DRS 以及小儿 DTC 的其他预后因素。
方法
纳入来自巴西南部四家 DTC 三级教学医院的年龄≤18 岁的患者。系统地检索了临床特征，所有患者均根据 2015 年美国甲状腺协会小儿 DTC 指南的风险分层系统（ATA 风险）和 DRS（优秀、不确定、生化或结构不完全反应）进行分类。在初始治疗后和最后一次随访时评估疾病状态。
结果
研究了 66 名年龄为 14.5±3.0 岁的患者，其中 54 名（81.8%）为女孩，62 名（93.9%）为甲状腺乳头状癌。肿瘤大小为 2.3cm（P25-75 为 1.6-3.5）；41 名（63.1%）有颈部转移，18 名（27.7%）有远处转移。所有患者均接受了全甲状腺切除术，63 名（95.5%）接受了放射性碘治疗。根据初始治疗后（n=63）的 DRS 对患者进行分类如下：21 名（33%）优秀，13 名（21%）不确定，6 名（9%）生化，23 名（37%）结构不完全反应。值得注意的是，在 6 年后（P25-75 为 2.7-10.0），大多数患者仍处于同一类别。有趣的是，通过接收者操作特征曲线对刺激后甲状腺球蛋白（sPOTg）进行截断分析表明，37.8ng/mL 的值对预测优秀反应具有 81%的敏感性和 100%的特异性。单因素分析中与持续性疾病相关的预后因素包括 TNM、ATA 风险、DRS 和 sPOTg。
结论
初始治疗后的 DRS 和 sPOTg 是疾病结果的有力预测因素，可能有助于确定小儿 DTC 的随访策略。
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