Kuhlen Michaela, Kunstreich Marina, Eilsberger Friederike, Lorenz Kerstin, Abele Michael, Brecht Ines B, Schneider Dominik T, Luster Markus, Redlich Antje
Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
Department of Pediatrics, Pediatric Hematology/Oncology, Otto-Von-Guericke-University, Magdeburg, Germany.
Eur Thyroid J. 2025 Aug 4;14(4). doi: 10.1530/ETJ-25-0035. Print 2025 Aug 1.
Pediatric differentiated thyroid carcinoma (pedDTC) is rare but increasingly prevalent, requiring multidisciplinary care to ensure optimal outcomes. In 2021, the pediatric national reference program of the German Malignant Endocrine Tumor (MET) registry was established to standardize the management of pedDTC, with a particular focus on radioactive iodine (RAI) use and minimizing treatment variability.
This study evaluated the program's first 3.5 years, including 43 inquiries concerning 39 patients with confirmed or suspected pedDTC. A weekly national expert tumor board provided individualized recommendations based on multidisciplinary input and risk stratification. Data were analyzed for demographic trends, therapeutic decisions, and short-term outcomes.
Among 34 patients with confirmed pedDTC, RAI use was reduced or omitted in 70.6% of cases, particularly among low-risk patients, in alignment with the American Thyroid Association 2015 guidelines. Surgical strategies were modified in 61.5% of cases to balance disease control with treatment-related morbidity. No systemic medical therapy was recommended during initial management. At a mean follow-up of 0.7 years, all patients were alive; persistent disease was observed in 15.4%.
The national reference program has successfully introduced a structured, individualized approach to the management of pedDTC in Germany. Ongoing data collection and longer follow-up will be essential to assess the long-term impact of this centralized, risk-adapted model.
儿童分化型甲状腺癌（pedDTC）较为罕见，但发病率日益上升，需要多学科护理以确保最佳治疗效果。2021年，德国恶性内分泌肿瘤（MET）登记处的儿童国家参考项目得以设立，旨在规范pedDTC的管理，尤其关注放射性碘（RAI）的使用并尽量减少治疗差异。
本研究评估了该项目最初的3.5年，包括43次咨询，涉及39例确诊或疑似pedDTC的患者。一个每周举行的全国专家肿瘤委员会根据多学科意见和风险分层提供个性化建议。对人口统计学趋势、治疗决策和短期结果进行了数据分析。
在34例确诊的pedDTC患者中，70.6%的病例减少或未使用RAI，尤其是在低风险患者中，这与美国甲状腺协会2015年的指南一致。61.5%的病例修改了手术策略，以平衡疾病控制与治疗相关的发病率。在初始治疗期间未推荐全身药物治疗。平均随访0.7年时，所有患者均存活；15.4%的患者观察到疾病持续存在。
国家参考项目已成功在德国引入了一种结构化、个性化的pedDTC管理方法。持续的数据收集和更长时间的随访对于评估这种集中化、风险适应性模型的长期影响至关重要。
