Sapuppo Giulia, Hartl Dana, Fresneau Brice, Hadoux Julien, Breuskin Ingrid, Baudin Eric, Rigaud Charlotte, Guerlain Joanne, Al Ghuzlan Abir, Leboulleux Sophie, Schlumberger Martin, Lamartina Livia
Endocrinology, Department of Clinical and Experimental Medicine, National Centre of Excellence Garibaldi Hospital University of Catania, Garibaldi-Nesima Hospital, 95122 Catania, Italy.
Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, 94805 Villejuif, France.
Cancers (Basel). 2021 Jul 24;13(15):3732. doi: 10.3390/cancers13153732.
Pediatric differentiated thyroid cancer (P-DTC) frequently presents with advanced disease. The study aim was to evaluate the outcome of P-DTC and a modified 2015 American Thyroid Association risk classification (ATA-R). A retrospective study of consecutive P-DTC patients was performed. The ATA-R for P-DTC was used with a cut-off of ≤ 5 N1a for low-risk. The outcome could be excellent response (ER) (thyroglobulin < 1 ng/mL and no evidence of disease (EoD) at imaging), biochemical incomplete response (BIR) (thyroglobulin ≥ 1 ng/mL and no EoD at imaging) or structural incomplete response (SIR) (EoD at imaging). We studied 260 P-DTC (70% females; median age at diagnosis 14 years; 93% total thyroidectomy and 82% lymph node dissection). The ATA-R was low in 30% cases, intermediate in 15% and high in 55%, including 31.5% with distant metastases. Radioiodine treatment was administered in 218 (83.8%), and further radioiodine and surgery was performed in 113 (52%) and 76 (29%) patients, respectively. After a median follow-up of 8.2 years, the outcome was ER in 193 (74.3%), BIR in 17 (6.5%) and SIR in 50 (19.2%). Independent predictors of SIR or BIR at first and last visits were ATA-R intermediate or high. P-DTC has an excellent prognosis. Modified ATA-R is a useful prognostic tool in P-DTC to guide management.
儿童分化型甲状腺癌（P-DTC）常表现为疾病进展。本研究旨在评估P-DTC的预后及改良的2015年美国甲状腺协会风险分类（ATA-R）。对连续的P-DTC患者进行了一项回顾性研究。P-DTC的ATA-R以≤5个N1a为低风险临界值。预后可能为良好反应（ER）（甲状腺球蛋白<1 ng/mL且影像学检查无疾病证据（EoD））、生化不完全反应（BIR）（甲状腺球蛋白≥1 ng/mL且影像学检查无EoD）或结构不完全反应（SIR）（影像学检查有EoD）。我们研究了260例P-DTC患者（70%为女性；诊断时中位年龄14岁；93%行全甲状腺切除术，82%行淋巴结清扫术）。30%的病例ATA-R为低风险，15%为中风险，55%为高风险，其中31.5%有远处转移。218例（83.8%）接受了放射性碘治疗，分别有113例（52%）和76例（29%）患者进一步接受了放射性碘治疗和手术。中位随访8.2年后，193例（74.3%）预后为ER，17例（6.5%）为BIR，50例（19.2%）为SIR。首次和末次就诊时SIR或BIR的独立预测因素为ATA-R中风险或高风险。P-DTC预后良好。改良的ATA-R是指导P-DTC管理的有用预后工具。
