1
|
Nesari Javan F, Askari E, Shafiei S, Roshanravan V, Aghaei A, Ayati N, Zakavi SR. The Prognostic Power of Preablation Stimulated Thyroglobulin in Children With Differentiated Thyroid Cancer. Endocr Pract 2024; 30:209-217. [PMID: 38092290 DOI: 10.1016/j.eprac.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To analyze prognostic factors in children with differentiated thyroid carcinoma (DTC) who have been treated in a single center in the last 27 years. METHODS We studied 126 children (≤18 years old) who have been treated with near-total thyroidectomy followed by radioiodine therapy and thyroid hormone replacement. Follow-up of the patients was done 2, 6, and 12 months after treatment and then by yearly evaluation. Response to treatment was defined according to the American Thyroid Association guidelines. RESULTS Papillary thyroid cancer was the main pathology (93.7%), and 52.4% of the patients had lymph node metastasis at presentation, which was extensive (>5) in 30% of the patients. Distant metastasis was seen in 8.8%. The mean initial dose of I-131 was 74 ± 42.2 MBq/kg. The median follow-up was 59 months and the median time to achieve an excellent response was 29 months. The preablation stimulated thyroglobulin (psTg) level was 202.4 ± 301.8 ng/mL in patients with first-year incomplete response compared with 11.2 ± 17.5 ng/mL in others (P =.001). Furthermore, using logistic regression, the psTg level was found to be the only significant predictor of distant metastasis, and psTg ≥ 13.75 ng/mL was the most powerful predictor of first-year incomplete response. Moreover, distant metastasis was more common in boys than in girls, and it took longer time for boys to achieve an excellent response. CONCLUSION The psTg level was the only significant predictor of distant metastases in children with DTC, and psTg ≥ 13.75 ng/mL was the most powerful predictor of first-year incomplete response.
Collapse
Affiliation(s)
- Farnaz Nesari Javan
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Emran Askari
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Susan Shafiei
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahid Roshanravan
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atena Aghaei
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narjess Ayati
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Seyed Rasoul Zakavi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
2
|
Xu Y, Shi L, Wu J, Li H, Wang Y, Liu B. Prognostic Value of Tumor Multifocality in Pediatric Papillary Thyroid Carcinoma: A Real-Life Multicentric Study. Otolaryngol Head Neck Surg 2023; 169:1606-1614. [PMID: 37222185 DOI: 10.1002/ohn.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/23/2023] [Accepted: 04/29/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To investigate the association of multifocality with clinical outcomes in pediatric papillary thyroid cancer. STUDY DESIGN Multicenter retrospective study of prospectively collected data. SETTING Tertiary referral center. METHODS This study included patients 18 years or younger who underwent total thyroidectomy and radioiodine ablation for papillary thyroid carcinoma (PTC) between 2005 and 2020 at 3 tertiary adult and pediatric hospitals in China. For disease-free survival (DFS), events were defined as persistent and/or recurrent diseases. The primary outcome was the association of tumor multifocality and DFS, assessed using Cox proportional hazards regression models. RESULTS One hundred and seventy-three patients (median age 16 years [range, 5-18 years]) were recruited. Multifocal diseases were seen in 59 patients (34.1%). After a median follow-up of 57 (range, 12-193 months) months, 63 (36.4%) patients had persistent diseases. There was a significant association between tumor multifocality and decreased DFS on univariable analysis (hazard ratio [HR] = 1.90, p = .01), yet it was nonsignificant after multivariate adjustment (HR = 1.20, p = .55). In a subgroup analysis of 132 pediatric patients with clinically M0 PTC, neither unadjusted HR (2.21, p = .06) nor adjusted HR (1.70, p = .27) of multifocal PTC was significantly higher in comparison to unifocal PTC. CONCLUSION In this highly selective surgical pediatric patient cohort with PTC, tumor multifocality was not an independent risk factor for decreased DFS.
Collapse
Affiliation(s)
- Yangmengyuan Xu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Shi
- Department of Nuclear Medicine, Chengdu Fifth People's Hospital, Chengdu, China
| | - Jie Wu
- Department of Nuclear Medicine, Panzhihua Central Hospital, Panzhihua University, Panzhihua, China
| | - Huilan Li
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Wang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Liu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
3
|
Wang H, Zhao S, Yao J, Yu X, Xu D. Factors influencing extrathyroidal extension of papillary thyroid cancer and evaluation of ultrasonography for its diagnosis: a retrospective analysis. Sci Rep 2023; 13:18344. [PMID: 37884592 PMCID: PMC10603168 DOI: 10.1038/s41598-023-45642-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/22/2023] [Indexed: 10/28/2023] Open
Abstract
Pathologists usually explore extrathyroidal extensions (ETEs) in thyroid cancer; however, sonographers are often not concerned with ETEs. We investigated factors influencing ETEs and the efficacy of ultrasound evaluation of thyroid capsule invasion. We retrospectively analysed 1933 papillary thyroid carcinoma patients who underwent thyroidectomy during 2018-2021. Patients were divided into three groups: no ETE, minor ETE (mETE), and gross ETE. Clinical characteristic differences were assessed using binary logistic regression analysis to identify ETE predictors, and the kappa test was performed to analyse consistency between ultrasonographic and pathological diagnoses of ETE. The mETE group was more likely to have larger tumour diameters and more extensive lymph node metastasis (LNM) than the no ETE group and more likely to be diagnosed in the isthmus. In the multivariate logistic regression analysis, longest tumour diameter, lesion site, LNM extent, and thyroglobulin concentration were significant mETE predictors. Minimal consistency existed between pathological and ultrasonographic examinations for neighbouring tissue invasion. Many clinical differences were observed between the no ETE and mETE groups, suggesting the importance of considering mETE. Therefore, sonographers should pay more attention to relationships between nodules and capsule and indicate these on ultrasound reports to provide more accurate preoperative ETE information for surgeons.
Collapse
Affiliation(s)
- Hui Wang
- Department of Ultrasound, Joint Service Support Force 903 Hospital, Hangzhou, China
| | - Shanshan Zhao
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing, China
| | - Jincao Yao
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital); Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| | - Xiuhua Yu
- Department of Ultrasound, Joint Service Support Force 903 Hospital, Hangzhou, China.
| | - Dong Xu
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital); Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China.
| |
Collapse
|
4
|
Radioiodine Therapy in Pediatric Differentiated Thyroid Cancer: Dosimetry, Clinical Care, and Future Challenges. Clin Nucl Med 2023; 48:158-167. [PMID: 36240802 DOI: 10.1097/rlu.0000000000004431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
ABSTRACT Thyroid cancer is very rare in children. 131 I therapy after thyroidectomy is established in pediatric differentiated thyroid cancer (DTC). Pediatric DTC guideline is silent on the optimum amount of 131 I that could be safely and effectively administered to children who are more radiosensitive. Like adult DTC, children are also given 131 I therapy empirically based either on age or body weight. Pediatric DTC guideline recommends that patient-specific dosimetry is important in children. Still, due to the low incidence rate and the practical difficulties of dosimetry, it has neither been established nor adopted in routine practice. This review article aims to discuss current approaches of 131 I therapy in children and young adult patients with DTC and dosimetric data obtained by several investigators. Efforts are required to simplify dosimetric procedures and precise results, especially in determining lesion size. We prefer 3-dimensional dosimetry over planar dosimetry, where lesion size could be measured accurately. 124 I PET/CT-based dosimetry is expected to give accurate dosimetric results. The most challenging aspect is that no randomized controlled trials are available to compare the empiric 131 I therapy results versus dosimetry-based treatment outcomes in children and young adults. Suppose dosimetry-based 131 I therapy could be shown to have better outcomes, namely, successful ablation rate, better disease-free survival, and lesser treatment-emergent adverse events than empirical 131 I treatment. In that case, one can argue in favor of the former. Unfortunately, no convincing study is currently available. Thus, there is a need for a randomized control trial to settle this issue.
Collapse
|
5
|
Tian T, Huang S, Dai H, Qi M, Liu B, Huang R. Radioactive Iodine-Refractory Pulmonary Metastases of Papillary Thyroid Cancer in Children, Adolescents, and Young Adults. J Clin Endocrinol Metab 2023; 108:306-314. [PMID: 36226635 DOI: 10.1210/clinem/dgac600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/05/2022] [Indexed: 01/27/2023]
Abstract
CONTEXT Few studies have explored radioactive iodine-refractory (RAIR) disease in children, adolescents, and young adults with papillary thyroid cancer (CAYA-PTC). OBJECTIVE This study systematically investigated the clinicopathologic characteristics and prognosis of CAYA-PTC with RAIR disease. METHODS Sixty-five patients with PTC aged ≤20 years were enrolled in this study, and all patients were confirmed to have pulmonary metastases. Clinicopathologic profiles were compared between the radioactive iodine-avid (RAIA) and RAIR groups. Univariate and multivariate regression analyses were performed to identify risk factors for RAIR status and progressive disease (PD). Gene alterations were detected in 17 patients. RESULTS Overall, 20 patients were included in the RAIR group, accounting for 30.8% (20/65) of all patients. No significant difference in pathologic characteristics was observed between patients aged <15 years and patients aged 15-20 years, but younger patients were more likely to develop RAIR disease (hazard ratio [HR] 3.500, 95% CI 1.134-10.803, P = .023). RET fusions were the most common genetic alterations in CAYA-PTC, but an association with RAIR disease was not detected (P = .210). RAIR disease (HR 10.008, 95% CI 2.427-41.268, P = .001) was identified as an independent predictor of PD. The Kaplan-Meier curve revealed a lower progression-free survival (PFS) and disease-specific survival (DSS) rate in the RAIR group than in the RAIA group (P < .001 and P = .039). Likewise, RAIR disease was a risk factor for unfavorable PFS in patients aged <15 years (P < .001). CONCLUSION RAIR disease occurs in one-third of CAYA-PTC with pulmonary metastases. Younger patients (aged < 15 years) are more susceptible to RAIR status, which leads to unfavorable PFS and DSS.
Collapse
Affiliation(s)
- Tian Tian
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Shuhui Huang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Hongyuan Dai
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Mengfang Qi
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Liu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Huang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
6
|
Muacevic A, Adler JR, Pinheiro S, Esteves S, Leite V, Santos R. Differentiated Thyroid Cancer in a Pediatric Population: Estimating the Risk of Recurrence and Evolution Over Time. Cureus 2023; 15:e34313. [PMID: 36860222 PMCID: PMC9970399 DOI: 10.7759/cureus.34313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 01/29/2023] Open
Abstract
Background Differentiated thyroid cancer (DTC) is the most common endocrine cancer during childhood, and the prognosis is usually good. The 2015 American Thyroid Association (ATA) pediatric guidelines for DTC classify patients into three categories (low, intermediate, and high) that represent the risk for persistent/recurrent disease. The "Dynamic Risk Stratification" (DRS) System showed that, in adults, reassessment of disease status during follow-up was a better predictor of disease status at the end of follow-up when compared to ATA risk stratification. This system is still not validated for the pediatric population with DTC. Our aim was to evaluate the usefulness of the DRS system in predicting DTC disease behaviour in this specific population. We also aimed to evaluate potential clinical-pathological factors associated with persistent disease at the end of follow-up. Methods A retrospective analysis of 39 pediatric patients (≤18 years) with DTC was conducted in our institution between 2007 and 2018, including 33 patients who had follow-up ≥ 12 months; these were classified into ATA risk groups and re-stratified according to their response to treatment at 12-24 months of follow-up. The associations between the ordinal variables of the baseline ATA risk group and the disease status re-evaluated 12-24 months after diagnosis (as per the DRS system) and at the end of follow-up were evaluated using a linear-by-linear association test. Gender, age at diagnosis, tumor size, multicentricity, extrathyroid extension, vascular invasion, lymph node metastasis, distant metastasis, and stimulated thyroglobulin (sTg) during the first RAI administration were evaluated as potential factors associated with persistent disease at 27 months after diagnosis using Firth's bias-reduced penalized-likelihood logistic regression. Results In this study, 39 patients were retrospectively analyzed, including 33 patients who had follow-ups ≥ 12 months with a median time of 56 (27-139) months who were classified in ATA risk groups and then re-stratified depending on their response to treatment between 12 and 24 months of follow-up. There was a statistically significant association between ATA risk groups and re-evaluation at 12 and 24 months (p=0.001) and between these two stratifications and the state of disease at final follow-up (p<0.001 for both). Factors with a statistically significant association with persistent disease at 27 months of follow-up were male sex, lymph node metastases at diagnosis, distant metastasis, extrathyroidal extension, and stimulated Tg values. Conclusions The assessment of the response to treatment between 12 and 24 months and at the end of follow-up refines the initial ATA risk stratification, confirming that dynamic risk evaluation is also helpful in the pediatric population.
Collapse
|
7
|
Sparano C, Moog S, Hadoux J, Dupuy C, Al Ghuzlan A, Breuskin I, Guerlain J, Hartl D, Baudin E, Lamartina L. Strategies for Radioiodine Treatment: What’s New. Cancers (Basel) 2022; 14:cancers14153800. [PMID: 35954463 PMCID: PMC9367259 DOI: 10.3390/cancers14153800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Radioiodine treatment (RAI) represents the most widespread and effective therapy for differentiated thyroid cancer (DTC). RAI goals encompass ablative (destruction of thyroid remnants, to enhance thyroglobulin predictive value), adjuvant (destruction of microscopic disease to reduce recurrences), and therapeutic (in case of macroscopic iodine avid lesions) purposes, but its use has evolved over time. Randomized trial results have enabled the refinement of RAI indications, moving from a standardized practice to a tailored approach. In most cases, low-risk patients may safely avoid RAI, but where necessary, a simplified protocol, based on lower iodine activities and human recombinant TSH preparation, proved to be just as effective, reducing overtreatment or useless impairment of quality of life. In pediatric DTC, RAI treatments may allow tumor healing even at the advanced stages. Finally, new challenges have arisen with the advancement in redifferentiation protocols, through which RAI still represents a leading therapy, even in former iodine refractory cases. RAI therapy is usually well-tolerated at low activities rates, but some concerns exist concerning higher cumulative doses and long-term outcomes. Despite these achievements, several issues still need to be addressed in terms of RAI indications and protocols, heading toward the RAI strategy of the future.
Collapse
Affiliation(s)
- Clotilde Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Sophie Moog
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Julien Hadoux
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Corinne Dupuy
- UMR 9019 CNRS, Université Paris-Saclay, Gustave Roussy, 94800 Villejuif, France
| | - Abir Al Ghuzlan
- Département de Biologie et Pathologie Médicales, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Ingrid Breuskin
- Département Anesthésie Chirurgie et Interventionnel, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Joanne Guerlain
- Département Anesthésie Chirurgie et Interventionnel, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Dana Hartl
- Département Anesthésie Chirurgie et Interventionnel, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Eric Baudin
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Livia Lamartina
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
- Correspondence:
| |
Collapse
|
8
|
Zhang JW, Fei MJ, Hou YQ, Tang ZY, Zhan WW, Zhou JQ. Long-term follow-up ultrasonography surveillance in a large cohort of patients with papillary thyroid carcinoma. Endocrine 2022; 77:297-304. [PMID: 35588346 DOI: 10.1007/s12020-022-03071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to investigate the predictive factors as well as the time and age course of recurrence/persistence in a large cohort of postoperative patients with papillary thyroid carcinoma (PTC) based on the long-term ultrasonography (US) follow-up data. METHODS Between January 2007 and December 2016, 3106 patients underwent surgery for PTC and at least two postoperative US follow-up examination over more than three years. Tumor recurrence/persistence was confirmed based on the follow-up US data and histopathological results. Univariate and multivariate analyses were performed to evaluate the predictive factors of tumor recurrence/persistence. Kaplan-Meier survival analysis was used to evaluate the recurrence-/persistence-free survival curve based on the US results. RESULTS A total of 321(10.3%) patients developed tumor recurrence/persistence during 54.3 months of mean follow-up (range 36-135 months), including 268(83.5%) cases of lymph node recurrence/persistence, 37 (11.5%) cases of non-lymph node recurrence/persistence, and 16(5%) cases of both types. Recurrence/persistence was observed using US examination at a mean interval of 23.6 ± 21.6 months (range 1-135 months) after surgery and peak incidence was observed 1-2 years after initial treatment. Younger (20-30 years old) and older (70-80 years old) patients had a higher proportion of tumor recurrence/persistence. Multifocality, advanced T and advanced N stages were independent risk factors of tumor recurrence/persistence. CONCLUSION Tumor recurrence/persistence of PTC usually occurs during the early postoperative period. For patients with multifocal cancer, advanced T and N stage, the US surveillance examination should be cautiously performed, especially in younger and older patients.
Collapse
Affiliation(s)
- Jing-Wen Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Meng-Jia Fei
- Department of Head and Neck Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Yi-Qing Hou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zhen-Yun Tang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Wei-Wei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Jian-Qiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| |
Collapse
|
9
|
Giles Şenyürek Y, İşcan Y, Sormaz İC, Poyrazoğlu Ş, Tunca F. The Role of American Thyroid Association Pediatric Thyroid Cancer Risk Stratification and BRAFV600E Mutation in Predicting the
Response to Treatment in Papillary Thyroid Cancer Patients ≤18 Years Old. J Clin Res Pediatr Endocrinol 2022; 14:196-206. [PMID: 35135184 PMCID: PMC9176084 DOI: 10.4274/jcrpe.galenos.2022.2021-10-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the role of risk stratification by the American Thyroid Association (ATA) pediatric thyroid cancer risk levels and BRAFV600E mutation to predict the response to treatment in papillary thyroid cancer (PTC) patients ≤18 years old. METHODS Clinical outcomes during a median period of 6 (2-21.8) years were assessed in 70 patients, according to ATA pediatric risk stratification, BRAFV600E mutation status, and dynamic risk stratification (DRS) at final follow-up. RESULTS Of 70 patients, 44 (63%), 14 (20%), and 12 (17%) were classified initially as low-, intermediate-, and high-risk, respectively. BRAFV600E mutation analysis data was available in 55 (78.6%) patients, of whom 18 (32.7%) had the BRAFV600E mutation. According to the final DRS, 61 (87%), two (3%), six (9%), and one (1%) patients were classified as an excellent, incomplete biochemical, incomplete structural, and indeterminate response, respectively. All ATA low-risk patients showed excellent response to treatment, whereas the rate of excellent response was 65.4% in intermediate- and high-risk levels (p<0.001). The rates of excellent response in BRAFV600E positive and negative patients were 83% and 92%, respectively (p=0.339). The rate of locoregional recurrence was significantly higher in BRAFV600E positive vs negative patients (33.3% vs 2.7% respectively, p=0.001). CONCLUSION ATA pediatric risk stratification is effective in predicting response to treatment in PTC patients ≤18 years old. The presence of BRAFV600E mutation was highly predictive for recurrence but had no significant impact on the rate of excellent response to treatment at final follow-up.
Collapse
Affiliation(s)
- Yasemin Giles Şenyürek
- İstanbul University, İstanbul Faculty of Medicine, Department of Surgery, İstanbul, Turkey,* Address for Correspondence: İstanbul University, İstanbul Faculty of Medicine, Department of Surgery, İstanbul, Turkey Phone: +90 542 804 92 32 E-mail:
| | - Yalın İşcan
- İstanbul University, İstanbul Faculty of Medicine, Department of Surgery, İstanbul, Turkey
| | - İsmail Cem Sormaz
- İstanbul University, İstanbul Faculty of Medicine, Department of Surgery, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Unit of Pediatric Endocrinology, İstanbul, Turkey
| | - Fatih Tunca
- İstanbul University, İstanbul Faculty of Medicine, Department of Surgery, İstanbul, Turkey
| |
Collapse
|
10
|
da Silva Breder JRA, Alves PAG, Araújo ML, Pires B, Valverde P, Bulzico DA, Accioly FA, Corbo R, Vaisman M, Vaisman F. Puberty and sex in pediatric thyroid cancer: could expression of estrogen and progesterone receptors affect prognosis? Eur Thyroid J 2022; 11:e210090. [PMID: 35113037 PMCID: PMC8963171 DOI: 10.1530/etj-21-0090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/03/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE A sharp increase in pediatric thyroid cancer incidence is observed during adolescence, driven mainly by girls. Differences in disease presentation across sexual maturity stages raise the question of whether sex steroids have a role in the heterogeneity. The aims of this study were to analyze the influence of puberty and sex on clinical presentation and prognosis and to evaluate the correlation between the expression of sex hormone receptors. DESIGN AND METHODS Clinical records and immunohistochemical of specimens from 79 patients were analyzed. Puberty was analyzed by two criteria: end of puberty and beginning, in which the age of 10 was the cutoff. RESULTS Postpubertal were more frequently classified as having low-risk disease and a lower frequency of persistent disease, especially when the completion of puberty was used as the criteria. Male sex was associated with a higher risk of persistent disease at the end of the observation period. Estrogen receptor α positivity was low in the entire sample, while progesterone receptor positivity was positive in 30% of the cases. Female hormone receptor expression was not associated with sex, American Thyroid Association risk score, persistent structural disease, or pubertal status. CONCLUSION Our study showed that the completion of puberty correlated best with the clinical behaviour of pediatric thyroid cancer. It was also shown that postpubertal patients have a less aggressive initial presentation and better outcomes. However, this observation could not be explained by the expression of estrogen and progesterone receptors in the primary tumors.
Collapse
Affiliation(s)
| | - Paulo Alonso Garcia Alves
- Endocrinology Department, Instituto Nacional do Cancer do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mario Lucio Araújo
- Pathology Department, Instituto Nacional do Cancer do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Barbara Pires
- Endocrinology Department, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Priscila Valverde
- Pathology Department, Instituto Nacional do Cancer do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniel Alves Bulzico
- Endocrinology Department, Instituto Nacional do Cancer do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Andrade Accioly
- Endocrinology Department, Instituto Nacional do Cancer do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rossana Corbo
- Endocrinology Department, Instituto Nacional do Cancer do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mario Vaisman
- Endocrinology Department, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Correspondence should be addressed to F Vaisman:
| | - Fernanda Vaisman
- Endocrinology Department, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Endocrinology Department, Instituto Nacional do Cancer do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Correspondence should be addressed to F Vaisman:
| |
Collapse
|
11
|
Redlich A, Luster M, Lorenz K, Lessel L, Rohrer TR, Schmid KW, Frühwald MC, Vorwerk P, Kuhlen M. Age, American Thyroid Association Risk Group, and Response to Therapy Are Prognostic Factors in Children With Differentiated Thyroid Cancer. J Clin Endocrinol Metab 2022; 107:e165-e177. [PMID: 34415989 DOI: 10.1210/clinem/dgab622] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Indexed: 12/27/2022]
Abstract
CONTEXT Against the background of increasing incidence, pediatric differentiated thyroid carcinoma (DTC) frequently presents with advanced disease and high recurrence rates while prognosis remains excellent. BACKGROUND We investigated the use of a pediatric classification and an adult response to therapy risk stratification for pediatric DTC patients and their implications for adaptation of treatment and follow-up. METHODS Data from patients aged <18 years with a diagnosis of primary DTC, registered with the German Pediatric Oncology Hematology-Malignant Endocrine Tumor registry since 1995, were analyzed. For risk prediction, patients were retrospectively assigned to the American Thyroid Association (ATA) risk groups and evaluated for response to therapy. RESULTS By October 2019, 354 patients with DTC had been reported (median age at diagnosis 13.7 years, range 3.6-17.9) with lymph node and distant metastases in 74.3% and 24.5%. Mean follow-up was 4.1 years (range 0-20.6). Ten-year overall and event-free survival (EFS) rates were 98.9% and 78.1%. EFS was impaired for patients with lymph node and distant metastases (P < .001), positive postoperative thyroglobulin (P = .006), incomplete resection (P = .002), sequential surgeries to achieve total thyroidectomy (P = .042), invasion of capsule (P < .001) and lymph vessels (P = .005), infiltration of surrounding soft tissues (P < .001), tumor multifocality (P < .001), ATA intermediate- and high-risk group (P < .001), and age <10 years (P < .001). Multivariate analysis revealed age <10 years at diagnosis, ATA high-risk level, and poor response to therapy as significant negative prognostic factors for EFS. CONCLUSION Age, ATA risk group, and response to therapy emerged as significant prognostic factors for EFS in pediatric patients with DTC, requiring risk-adapted individualized therapy and follow-up.
Collapse
Affiliation(s)
- Antje Redlich
- Pediatric Oncology Department, Otto von Guericke University Children's Hospital, Magdeburg, Germany
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Lienhard Lessel
- Pediatric Oncology Department, Otto von Guericke University Children´s Hospital, Magdeburg, Germany
| | - Tilman R Rohrer
- Department of Pediatric Endocrinology, University Children's Hospital, Saarland University Medical Center, Homburg, Germany
| | - Kurt W Schmid
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael C Frühwald
- Paediatric and Adolescent Medicine, University Medical Center Augsburg, Germany
| | - Peter Vorwerk
- Pediatric Oncology Department, Otto von Guericke University Children´s Hospital, Magdeburg, Germany
| | - Michaela Kuhlen
- Paediatric and Adolescent Medicine, University Medical Center Augsburg, Germany
| |
Collapse
|
12
|
Pattern analysis for prognosis of differentiated thyroid cancer according to preoperative serum thyrotropin levels. Sci Rep 2021; 11:22322. [PMID: 34785735 PMCID: PMC8595371 DOI: 10.1038/s41598-021-01898-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Serum thyrotropin (TSH) level after thyroid surgery affects the prognosis of differentiated thyroid cancer (DTC). However, the effects of preoperative serum TSH levels on the prognosis of DTC remain contradictory. In this study, to better understand the relationship between preoperative TSH levels and the prognosis of DTC, we performed pattern analysis of prognostic factors of DTC according to preoperative serum TSH levels. We retrospectively reviewed the clinical records of patients who were diagnosed and treated for DTC at the Samsung Medical Center, between 1994 and 2016. We reviewed preoperative serum TSH levels and performed a pattern analysis with prognostic risk factors for DTC. For pattern analysis, TSH was divided into 10 groups of equal fractions (TSH decile). We found a linear association between preoperative TSH levels and extra-thyroidal extension and lymph node metastasis. However, primary tumor size and initial distant metastasis showed a bimodal peak, which was similar to the pattern of overall and disease-specific death. We found that preoperative TSH range which showed the lowest mortality rate was about 0.8 to 1.59 mIU/L, which are slightly lower normal TSH levels. Although there was no linear trend, the primary tumor size, initial distant metastasis, and mortality of DTC were closely related with preoperative TSH decile and they showed a bimodal pattern. The results obtained in this study provide additional information for understanding the association between preoperative TSH levels and DTC prognosis.
Collapse
|
13
|
Dong P, Qu Y, Yang L, Xiao L, Huang R, Li L. Outcomes after radioiodine ablation in patients with thyroid cancer: Long-term follow-up of a Chinese randomized clinicaltrial. Clin Endocrinol (Oxf) 2021; 95:782-789. [PMID: 34368999 DOI: 10.1111/cen.14563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Two large randomized trials of patients with differentiated thyroid cancer (DTC) reported recently (HiLo and ESTIMABL1) found that the recurrence rate among patients who underwent 1.1 GBq radioactive iodine (RAI) ablation was not higher than that of patients who underwent 3.7 GBq radioactive iodine (RAI) ablation. However, no similar studies have been conducted in China. We aimed to report clinical outcomes in Chinese patients with low/intermediate risk of recurrence DTC after long-term follow-up, and evaluate the risk factors that influence the presence or absence of incomplete response at the final follow-up. DESIGN A long-term follow-up of a Chinese randomized clinical trial (October 2014 and February 2021) was conducted. PATIENTS A total of 506 DTC patients at low/intermediate risk of recurrence who were randomized into two groups to receive 1.1 (n = 251) or 3.7 GBq (n = 255) RAI ablation following thyroid hormone withdrawal were followed on levothyroxine treatment for a median of 4.5 years (range: 1.6-6.3). MEASUREMENTS Suppressed serum thyroglobulin (Tg) and anti-thyroglobulin antibody (TgAb) levels were determined, and neck ultrasonography was performed. RESULTS At the final follow-up, 499 (98.6%) patients showed an excellent response. The other seven patients (two patients underwent 1.1 GBq and five patients underwent 3.7 GBq RAI ablation, respectively) showed either structural incomplete response (lymph node metastasis, n = 1), biochemical incomplete response (increased serum Tg ≥ 1 ng/ml, or increased positive TgAb levels, n = 5), or indeterminate response (stable positive TgAb levels, n = 1). The risk of incomplete response at the final follow-up was significantly increased in patients with stimulated serum Tg ≥ 10 ng/ml at ablation (p = .003) and in patients with unsuccessful ablation (p = .008). CONCLUSION Our findings indicated that there was no difference in the long-term outcomes with RAI ablation using either 1.1 or 3.7 GBq in patients with low/intermediate risk of recurrence DTC, and 1.1 GBq RAI might be suitable for patients who are recommended for ablation.
Collapse
Affiliation(s)
- Ping Dong
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Yuan Qu
- Department of Medical Imaging, East Hospital, Tongji University, Shanghai, P. R. China
| | - Liu Yang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Liu Xiao
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Rui Huang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Lin Li
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, P. R. China
| |
Collapse
|
14
|
Xu Y, Wang Y, Zhang X, Huang R, Tian R, Liu B. Prognostic value of lymph node ratio in children and adolescents with papillary thyroid cancer. Clin Endocrinol (Oxf) 2021; 95:649-656. [PMID: 33914928 DOI: 10.1111/cen.14491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Neck lymph node (LN) metastasis is a common feature of paediatric papillary thyroid cancer, and LN ratio (LNR) is defined as the ratio of the number of positive LNs excised to the total number of removed. Unlike in adults, few data are available regarding the clinical implication of LNR in the paediatric population. Our purpose was to investigate the association of LNR with clinical outcomes in paediatric papillary thyroid cancer. DESIGN & METHODS The study retrospectively reviewed 136 consecutive children and adolescents with papillary thyroid cancer and LN involvement but no initial distant metastasis. Initial treatment, included in all patients a total thyroidectomy with central and/or lateral neck dissection followed by radioactive iodine ablation. Within the neck dissections, total number of LNs removed, total positive LNs and LN ratios were determined. The effect of clinicopathologic characteristics and intraoperative findings on persistent and recurrent diseases were analysed by univariate and multivariate analyses. RESULTS Median number of positive LNs was 9, and median LNR was 0.4. During a median follow-up of 49 months (range, 12.0-139 months), persistent disease occurred in 43 (31.6%) patients. The multivariable analysis showed that age and LNR were the independent factors predictive of persistent disease. Patients with a LNR >0.34 exhibited a threefold higher risk of persistent disease after initial therapy than the counterparts (P = .02). CONCLUSION Our findings suggest that LNR was an independent determinant predictive of persistent disease after initial therapy in children and adolescents with papillary thyroid cancer.
Collapse
Affiliation(s)
- Yangmengyuan Xu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Wang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xinyue Zhang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Huang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Tian
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Liu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
15
|
Pediatric Thyroid Cancer: To Whom Do You Send the Referral? Cancers (Basel) 2021; 13:cancers13174416. [PMID: 34503225 PMCID: PMC8430721 DOI: 10.3390/cancers13174416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Pediatric thyroidectomies are performed by pediatric and adult general surgeons as well as pediatric and adult otolaryngologists. Surgeons may be high or low-volume thyroid surgeons. In this review, we discuss the roles of surgical subspecialty, surgeon volume, and institution volume as they relate to pediatric thyroidectomy outcomes. We also present institutional approaches to multidisciplinary treatment of pediatric thyroid cancer. Abstract Pediatric thyroid cancer is rare, but increasing in annual incidence. Differentiated thyroid cancer in pediatric patients is treated surgically. Pediatric thyroidectomies are performed by general surgeons, otolaryngologists, general pediatric surgeons, and pediatric otolaryngologists. In a comprehensive literature review, we discuss the evidence supporting the importance of surgeon subspecialty and surgeon volume on outcomes for pediatric thyroid cancer patients. Pediatric general surgeons and pediatric otolaryngologists perform most pediatric thyroidectomies. Certain subpopulations specifically benefit from a combined approach of a pediatric surgeon and a high-volume thyroid surgeon. The correlation between high-volume surgeons and lower complication rates in adult thyroid surgery applies to the pediatric population; however, the definition of high-volume for pediatric thyroidectomies requires further investigation. The development of dedicated pediatric thyroid malignancy centers and multidisciplinary or dual-surgeon approaches are advantageous.
Collapse
|
16
|
Lin M, Su Y, Wei W, Gong Y, Huang Y, Zeng J, Li L, Shi H, Chen S. Extra-Thyroid Extension Prediction by Ultrasound Quantitative Method Based on Thyroid Capsule Response Evaluation. Med Sci Monit 2021; 27:e929408. [PMID: 33819211 PMCID: PMC8034237 DOI: 10.12659/msm.929408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this study was to assess the interaction between thyroid malignancies and thyroid anterior capsule by ultrasound quantification to determine extra-capsular invasion. Material/Methods A total of 145 patients preoperatively diagnosed with malignant nodules under the thyroid anterior capsule were selected and routinely examined by ultrasound. The length of the nodules (from the junction of the nodule capsule to the deepest point of the nodule, vertical diameter, V) and the distance between the nodule protruding from thyroid capsule and the highest protruding (ledge length, L) nodule were used to obtain the L/V ratio. These parameters where then used to compare the efficacy of predicting extra-thyroid extension (ETE) between L/V, the aspect ratio of the tumor, and manual judgment. Results Out of 145 nodules, there were 63 ETEs and 82 non-ETEs determined by ultrasound. Extra-capsular invasion was associated with L//V ratio, but there was no significant correlation between capsular invasion and AR (aspect ratio), age, location, or presence of clustered calcification. The ability of the ratio of L/V to predict extra-capsular invasion was superior to the predictive ability of the AR ratio. With a Youden index of 0.593, the L/V ratio was 0.2325. The use of the L/V ratio to determine the presence of ETE was superior to subjective visual judgment. Conclusions The calculation of L/V ratio by ultrasound could more precisely predict the ETE compared with manual judgment, which indirectly reflects the interaction between thyroid capsule and malignant nodules. The above conclusions need to be confirmed by a range of cases.
Collapse
Affiliation(s)
- Minghang Lin
- Department of Ultrasound, Fuqing City Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China (mainland).,Department of Ultrasound, 1st Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Yiming Su
- Department of Ultrasound, 1st Affiliated Hospital of Xiamen University, Xiamen, Fujian, China (mainland)
| | - Weili Wei
- Department of Ultrasound, 1st Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Yiran Gong
- Department of Ultrasound, 1st Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Yinan Huang
- Department of Ultrasound, 1st Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Jinshu Zeng
- Department of Ultrasound, 1st Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Liya Li
- Department of Ultrasound, 2nd Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China (mainland)
| | - Haihong Shi
- Department of Ultrasound, 2nd Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China (mainland)
| | - Shuqiang Chen
- Department of Ultrasound, 1st Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| |
Collapse
|
17
|
Zhang X, Jiang L, Liu L, Liu B. Influence of body mass index at diagnosis on outcome of thyroid cancer in children and adolescents. Surgery 2021; 169:1373-1378. [PMID: 33612290 DOI: 10.1016/j.surg.2020.12.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/20/2020] [Accepted: 12/30/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To systemically examine the relationship between body mass index, the extent of thyroid cancer and metastatic burden at diagnosis, and overall outcomes in children and adolescents with thyroid cancer. METHODS A retrospective series of children and adolescents with differentiated thyroid cancer who underwent total thyroidectomy and 131I therapy was analyzed. Body mass index (BMI) at the time of surgery was assessed. The Chinese age- and sex-specific BMI percentile criteria for screening overweight and obesity in children and adolescents were used to define the overweight and obesity among patients. The relationship between BMI and clinicopathological features and clinical outcomes of the disease was evaluated by logistic regression modeling, incorporating the eighth edition of the American Joint Committee on Cancer TNM staging system and the 2015 American Thyroid Association guidelines. RESULTS This study included 181 children and adolescents with differentiated thyroid cancer (82.9% females, median age 17 years). The mean BMI was 21.0 ± 3.9 kg/m2; 77.9% of the patients (N = 141) were normal weight, 13.2% (N = 24) were overweight, and 8.8% (N = 16) were obese. No positive associations were noted between BMI and T, N, or M stage on logistic regression analyses. The absence of an association was also demonstrated on analysis by BMI categories. After a median follow-up of 51 months, 114 children and adolescents (63.0%) had achieved excellent response to therapy. No associations were noted for persistent/recurrent disease among BMI groups. CONCLUSION Our study highlights the absence of increased disease burden at the time of thyroid cancer diagnosis in pediatric patients with high BMI along with the same prognosis compared with normal-weight pediatric patients.
Collapse
Affiliation(s)
- Xinyue Zhang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lisha Jiang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lina Liu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Liu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
18
|
Karapanou O, Tzanela M, Rondogianni P, Dacou-Voutetakis C, Chiotis D, Vlassopoulou B, Vassiliadi D, Kanaka-Gantenbein C, Tsagarakis S. Long-term outcome of differentiated thyroid cancer in children and young adults: risk stratification by ATA criteria and assessment of pre-ablation stimulated thyroglobulin as predictors of disease persistence. Endocrine 2020; 70:566-574. [PMID: 32533509 DOI: 10.1007/s12020-020-02378-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Differentiated thyroid cancer (DTC) has an increasing incidence in childhood and adolescence but long-term outcome data are limited. We aimed to identify possible risk factors associated with disease persistence, with special focus on the usefulness of ATA risk stratification system and pre-ablation stimulated thyroglobulin (Tg) levels. METHODS We retrospectively studied 103 patients, 79 females (76.7%), aged 15.6 ± 3.2 years (range 5-21 years) who underwent total thyroidectomy for DTC. Patients were classified by ATA risk stratification criteria as low, intermediate, and high risk for recurrence. All, except five with papillary microcarcinoma, received radioactive iodine (RAI) treatment. RESULTS At diagnosis, 44.7% of patients had cervical lymph node and 7.8% pulmonary metastases. Amongst the 72 patients with long-term follow-up data, 31.9% had persistent disease. Lymph node as well as pulmonary metastases and increased pre-ablation stimulated thyroglobulin (Tg) levels were associated with persistent disease. The risk of persistent disease was significantly higher in both the intermediate- (OR 17.95; 95% CI 2.66-120.94, p < 0.01) and high-risk (OR 17.65; 95% CI 4.47-69.74, p < 0.001) groups. ROC curve analysis showed that a pre-ablation Tg level higher than 14 ng/ml had a sensitivity of 94.7% to predict persistence, corresponding to a positive (PPV) and negative predictive values (NPV) of 66.7% and 93.8%, respectively. CONCLUSIONS ATA risk stratification was validated in our population of children and young adults with DTC. Moreover, pre-ablation stimulated Tg levels of <14 ng/ml were associated with a low risk of long-term persistence and may therefore serve as a marker to identify patients who may need less intensive surveillance.
Collapse
Affiliation(s)
- Olga Karapanou
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, 10676, Athens, Greece.
| | - Marinella Tzanela
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, 10676, Athens, Greece
| | - Phoebe Rondogianni
- Department of Nuclear Medicine, Evangelismos Hospital, 10676, Athens, Greece
| | - Catherine Dacou-Voutetakis
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Faculty of Medicine, National and Kapodistrian University of Athens, Medical School, "Aghia Sofia" Children's Hospital, 11527, Athens, Greece
| | - Dimitrios Chiotis
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Faculty of Medicine, National and Kapodistrian University of Athens, Medical School, "Aghia Sofia" Children's Hospital, 11527, Athens, Greece
| | - Barbara Vlassopoulou
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, 10676, Athens, Greece
| | - Dimitra Vassiliadi
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, 10676, Athens, Greece
| | - Christina Kanaka-Gantenbein
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Faculty of Medicine, National and Kapodistrian University of Athens, Medical School, "Aghia Sofia" Children's Hospital, 11527, Athens, Greece
| | - Stylianos Tsagarakis
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, 10676, Athens, Greece
| |
Collapse
|
19
|
Abstract
An increasing number of children are diagnosed with thyroid cancer. Most patients do not have an identifiable cause; however, tumor predisposition syndromes may be associated with development of both differentiated and medullary thyroid cancer. With an excellent prognosis for most patients, the goal of therapy is to optimize outcome and reduce complications. The increased knowledge of the oncogenic drivers provides opportunities to improve the accuracy of diagnosis, stratify surgery, and select systemic therapy that may be considered for neoadjuvant and adjuvant treatment. Treatment complications can be reduced by referral to regional, high-volume pediatric thyroid centers.
Collapse
Affiliation(s)
- Andrew J Bauer
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, 3500 Civic Center Boulevard, Buerger Center, 12-149, Philadelphia, PA 19104, USA; Department of Pediatrics, The Perelman School of Medicine, The University of Pennsylvania, 415 Curie Boulevard, Philadelphia, PA 19104, USA.
| |
Collapse
|
20
|
Sugino K, Nagahama M, Kitagawa W, Ohkuwa K, Uruno T, Matsuzu K, Suzuki A, Tomoda C, Hames KY, Akaishi J, Masaki C, Ito K. Distant Metastasis in Pediatric and Adolescent Differentiated Thyroid Cancer: Clinical Outcomes and Risk Factor Analyses. J Clin Endocrinol Metab 2020; 105:5894448. [PMID: 32813019 DOI: 10.1210/clinem/dgaa545] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/11/2020] [Indexed: 12/19/2022]
Abstract
CONTEXT The specific characteristics of pediatric and adolescent differentiated thyroid cancer (DTC) is the more frequent occurrence of distant metastasis (DM) compared with adult DTC. OBJECTIVE To investigate the clinical outcomes of DM in this population and analyze risk factors related to DM. DESIGN, SETTING, AND PARTICIPANTS Medical records of 171 patients with DTC < 19 years old, who underwent initial surgery between 1979 and 2014 were retrospectively reviewed. MAIN OUTCOME MEASURE Clinical responses to radioiodine (RAI) therapy evaluated by the American Thyroid Association (ATA) guidelines for adult DTC and Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Risk factors related to distant-metastasis-free survival (DMFS). RESULTS DM was observed in 29 patients, and all were lung metastases. The pattern of lung metastasis was classified into 3 categories: macronodular, micronodular, and no apparent nodule (detected only by RAI scintigraphy). Patients with excellent responses according to the ATA guideline criteria or complete remission of the RECIST criteria were most frequently observed in those with no apparent nodule. Significant factors related to DMFS were sex, clinical lymph node metastasis (LNM), extrathyroidal extension, and number of LNM. Subjects were divided into 3 groups according to the number of risk factors: low risk (no risk factors); intermediate risk (1 risk factor); and high risk (≥2 risk factors). Twenty-year DMFS rates in the low-, intermediate-, and high-risk groups were 99.0%, 71.7%, and 28.6%, respectively. CONCLUSION To achieve the full efficacy of RAI therapy, early diagnosis of DM before apparent metastases appear is desirable. The selective approach would be preferable for pediatric and adolescent DTC.
Collapse
Affiliation(s)
| | | | | | - Keiko Ohkuwa
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | | | | | | | | | | | | | - Chie Masaki
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | - Koichi Ito
- Department of Surgery, Ito Hospital, Tokyo, Japan
| |
Collapse
|
21
|
Rangel-Pozzo A, Sisdelli L, Cordioli MIV, Vaisman F, Caria P, Mai S, Cerutti JM. Genetic Landscape of Papillary Thyroid Carcinoma and Nuclear Architecture: An Overview Comparing Pediatric and Adult Populations. Cancers (Basel) 2020; 12:E3146. [PMID: 33120984 PMCID: PMC7693829 DOI: 10.3390/cancers12113146] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022] Open
Abstract
Thyroid cancer is a rare malignancy in the pediatric population that is highly associated with disease aggressiveness and advanced disease stages when compared to adult population. The biological and molecular features underlying pediatric and adult thyroid cancer pathogenesis could be responsible for differences in the clinical presentation and prognosis. Despite this, the clinical assessment and treatments used in pediatric thyroid cancer are the same as those implemented for adults and specific personalized target treatments are not used in clinical practice. In this review, we focus on papillary thyroid carcinoma (PTC), which represents 80-90% of all differentiated thyroid carcinomas. PTC has a high rate of gene fusions and mutations, which can influence the histologic subtypes in both children and adults. This review also highlights telomere-related genomic instability and changes in nuclear organization as novel biomarkers for thyroid cancers.
Collapse
Affiliation(s)
- Aline Rangel-Pozzo
- Cell Biology, Research Institute of Oncology and Hematology, University of Manitoba, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Luiza Sisdelli
- Genetic Bases of Thyroid Tumors Laboratory, Division of Genetics, Department of Morphology and Genetics, Universidade Federal de São Paulo/EPM, São Paulo, SP 04039-032, Brazil; (L.S.); (M.I.V.C.); (J.M.C.)
| | - Maria Isabel V. Cordioli
- Genetic Bases of Thyroid Tumors Laboratory, Division of Genetics, Department of Morphology and Genetics, Universidade Federal de São Paulo/EPM, São Paulo, SP 04039-032, Brazil; (L.S.); (M.I.V.C.); (J.M.C.)
| | - Fernanda Vaisman
- Instituto Nacional do Câncer, Rio de Janeiro, RJ 22451-000, Brazil;
| | - Paola Caria
- Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy
| | - Sabine Mai
- Cell Biology, Research Institute of Oncology and Hematology, University of Manitoba, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Janete M. Cerutti
- Genetic Bases of Thyroid Tumors Laboratory, Division of Genetics, Department of Morphology and Genetics, Universidade Federal de São Paulo/EPM, São Paulo, SP 04039-032, Brazil; (L.S.); (M.I.V.C.); (J.M.C.)
| |
Collapse
|
22
|
Overman RE, Hsieh LB, Menon R, Thomas IH, Bruch SW. 4-Hour postoperative PTH level predicts hypocalcemia after thyroidectomy in children. J Pediatr Surg 2020; 55:1265-1269. [PMID: 31892477 DOI: 10.1016/j.jpedsurg.2019.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 10/31/2019] [Accepted: 11/30/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Hypocalcemia occurs frequently after a total thyroidectomy in pediatric patients. Four hour postoperative PTH monitoring predicts the need for calcium supplementation in the adult thyroidectomy population. We evaluated the role of the 4 h postoperative PTH level in determining the need for calcium supplementation after thyroidectomy in the pediatric population. METHODS This is a retrospective review of children undergoing total thyroidectomy by a single pediatric surgeon from July 2011 through July 2018. Intact PTH obtained four hours postoperatively determined the need for calcium supplementation for patients beginning in November 2014 onward. Serum total calcium levels were monitored concurrently with serum intact PTH levels. Serum calcium levels were followed in our Multispecialty Pediatric Endocrine Surgery clinic within the month following thyroidectomy. RESULTS From July 2011 through July 2018, there were a total of 56 total thyroidectomies at our institution. Prior to November 2014, all pediatric total thyroidectomies received calcium supplementation per our institutional protocol. Based on ionized calcium levels, 26.3% (5/19) of children developed hypocalcemia. From November 2014 to July 2018, 37 pediatric patients required total thyroidectomies. 29.7% (11/37) had low 4-h postoperative PTH levels. 72.7% (8/11) patients with low 4-h postoperative PTH levels had corresponding postoperative day 1 total calcium levels less than 8.5 or ionized calcium levels less than 1.12, and five children (45.5%) developed symptomatic hypocalcemia. 70% (26/37) of children had normal 4-h postop PTH levels, with only 5 (19%) ever developing hypocalcemia. No patients with a normal postop PTH level developed symptomatic hypocalcemia or required IV calcium repletion. A single 4-h postoperative PTH <10 pg/dl for identifying hypocalcemia has a sensitivity of 81% and specificity of 91%, with AUC 0.81. CONCLUSION The 4-h postoperative serum PTH level can help determine the need for calcium supplementation in pediatric patients undergoing total thyroidectomy, thereby reducing unnecessary calcium supplementation and serial lab draws to monitor for postoperative hypocalcemia. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- R Elliott Overman
- Division of Pediatric Surgery, Department of Surgery, University of Michigan, 1540 E Hospital Dr. Rm 4972, Ann Arbor, MI 48109.
| | - Lily B Hsieh
- Division of Pediatric Surgery, Department of Surgery, University of Michigan, 1540 E Hospital Dr. Rm 4972, Ann Arbor, MI 48109.
| | - Ram Menon
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, University of Michigan, 1500 E Medical Center Dr, D1205 MPB, Ann Arbor, MI 48109.
| | - Inas H Thomas
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, University of Michigan, 1500 E Medical Center Dr, D1205 MPB, Ann Arbor, MI 48109.
| | - Steven W Bruch
- Division of Pediatric Surgery, Department of Surgery, University of Michigan, 1540 E Hospital Dr. Rm 4972, Ann Arbor, MI 48109.
| |
Collapse
|
23
|
Liu L, Zhang X, Tian T, Huang R, Liu B. Prognostic Value of Pre-Ablation Stimulated Thyroglobulin in Children and Adolescents with Differentiated Thyroid Cancer. Thyroid 2020; 30:1017-1024. [PMID: 31964278 DOI: 10.1089/thy.2019.0585] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose: To systemically investigate the prognostic value of pre-ablation stimulated thyroglobulin (s-Tg) in children and adolescents with differentiated thyroid cancer. Methods: Clinical records from 118 children and adolescents were retrospectively reviewed. Results: The median age was 16 years, and the majority were female (79.7%). All children and adolescents underwent total thyroidectomy and received radioactive iodine therapy. After a median follow-up of 5.3 years, 68 (57.6%) patients were disease free, while 50 patients (42.4%) had persistent/recurrent disease. In multivariate analysis, pre-ablation s-Tg and M1 were the independent predictive factors for persistent/recurrent disease. According to the receiver operating curve analysis, the best pre-ablation s-Tg cutoff to predict disease-free status was 17.8 ng/mL with a negative predictive value of 96.8%. Integration of pre-ablation s-Tg into American Thyroid Association pediatric risk categories indicated that the presence of pre-ablation s-Tg ≤17.8 ng/mL was associated with a decreased chance of having persistent/recurrent disease in intermediate- and high-risk patients (22.6% to 2.6% in intermediate-risk patients, and 64.4% to 5.6% in high-risk patients). Conclusions: Our findings suggest that pre-ablation s-Tg has the capability of predicting the clinical outcomes in children and adolescents with thyroid cancer.
Collapse
Affiliation(s)
- Lina Liu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xinyue Zhang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Tian Tian
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Huang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Liu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
24
|
Bauer AJ. Papillary and Follicular Thyroid Cancer in children and adolescents: Current approach and future directions. Semin Pediatr Surg 2020; 29:150920. [PMID: 32571505 DOI: 10.1016/j.sempedsurg.2020.150920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
An increasing number of children are diagnosed with differentiated thyroid cancer. With an excellent prognosis for the majority of pediatric patients, the goal of therapy is to optimize outcome while reducing complications. Increased knowledge of the somatic, oncogenic driver mutations provides opportunities to improve the accuracy of diagnosis, to stratify surgery, and to treat patients with morbidly invasive or refractory disease. Treatment complications can be reduced by referral to regional, high-volume pediatric thyroid centers.
Collapse
Affiliation(s)
- Andrew J Bauer
- The Thyroid Center, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, 3500 Civic Center Boulevard, Buerger Center, 12-149, Philadelphia, PA USA 19104; Department of Pediatrics, The Perelman School of Medicine, The University of Pennsylvania, 415 Curie Blvd, Philadelphia, PA USA 19104.
| |
Collapse
|
25
|
Sugino K, Nagahama M, Kitagawa W, Ohkuwa K, Uruno T, Matsuzu K, Suzuki A, Tomoda C, Hames KY, Akaishi J, Masaki C, Ito K. Risk Stratification of Pediatric Patients with Differentiated Thyroid Cancer: Is Total Thyroidectomy Necessary for Patients at Any Risk? Thyroid 2020; 30:548-556. [PMID: 31910105 DOI: 10.1089/thy.2019.0231] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: In the recent American Thyroid Association (ATA) guidelines for adult differentiated thyroid carcinoma (DTC) patients, risk stratification is clearly defined and lobectomy is acceptable for low-risk DTC. However, risk stratification for children with DTC in the ATA pediatric guidelines is rather unclear, and total thyroidectomy is recommended for all patients with any risk. The aim of this study was to attempt risk stratification based on our experience and to consider the appropriate extent of thyroidectomy, especially for low-risk DTC in the pediatric population. Patients and Methods: The subjects were 153 patients with DTC ≤18 years old, including 58 patients ≤15 years old and 136 female patients, who underwent initial curative surgery in our hospital between 1979 and 2014. Underlying pathology was papillary thyroid carcinoma in 130 patients and follicular thyroid carcinoma in 23. Risk factors related to disease-free survival (DFS) were analyzed and risk stratification was performed. Results: No patient died of the disease and 34 patients (22.2%) developed recurrences. At initial surgery, 30 patients (19.6%) had lymph node metastases diagnosed before initial surgery (cN1) and 9 (5.9%) had gross extrathyroidal extension (ETE). Significant factors related to DFS on multivariate analysis were cN1, ETE, and number of metastatic lymph nodes (NMLNs) ≥10, including microscopic MLNs. According to these factors, subjects were divided into three categories: low risk (no risk factors, n = 89); intermediate risk (1 risk factor, n = 37); and high risk (≥2 risk factors, n = 27). Ten-year DFS rates in the low-, intermediate-, and high-risk groups were 96%, 83%, and 48%, respectively. Only 12% of low-risk patients underwent total thyroidectomy. Because NMLNs become obvious only after surgery, another analysis after excluding "NMLNs" as a factor showed that cN and ETE were significant factors related to poor DFS. According to these two factors, risk stratification was attempted in the same manner. Ten-year DFS rates in the low- (no risk factor, n = 117), intermediate- (one risk factor, n = 29), and high-risk (two risk factors, n = 7) groups were 92%, 59%, and 43%, respectively. Only 12% of low-risk patients underwent total thyroidectomy. Conclusions: For low-risk pediatric patients, lobectomy may be sufficient as the initial surgical procedure.
Collapse
Affiliation(s)
| | | | | | - Keiko Ohkuwa
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | | | | | | | | | | | | | - Chie Masaki
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | - Koichi Ito
- Department of Surgery, Ito Hospital, Tokyo, Japan
| |
Collapse
|
26
|
Zhang X, Liu L, Chen Y, Huang R, Liu B. Prognostic value of post‐ablation
131
I scintigraphy in children with thyroid cancer. Head Neck 2020; 42:1738-1745. [PMID: 31976610 DOI: 10.1002/hed.26088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/01/2020] [Accepted: 01/10/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Xinyue Zhang
- Department of Nuclear Medicine, West China HospitalSichuan University Chengdu China
| | - Lina Liu
- Department of Nuclear Medicine, West China HospitalSichuan University Chengdu China
| | - Yu Chen
- Department of General Surgery, West China HospitalSichuan University Chengdu China
| | - Rui Huang
- Department of Nuclear Medicine, West China HospitalSichuan University Chengdu China
| | - Bin Liu
- Department of Nuclear Medicine, West China HospitalSichuan University Chengdu China
| |
Collapse
|
27
|
Performance of the American Thyroid Association Risk Classification in a Single Center Cohort of Pediatric Patients with Differentiated Thyroid Cancer: A Retrospective Study. J Thyroid Res 2019; 2019:5390316. [PMID: 31275541 PMCID: PMC6582784 DOI: 10.1155/2019/5390316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 03/13/2019] [Indexed: 01/03/2023] Open
Abstract
Introduction Differentiated thyroid cancer (DTC) is the most common endocrine malignancy in children. Retrospective studies show conflicting results regarding predictors of persistent and recurrent disease after initial therapy. In 2015, the American Thyroid Association (ATA) proposed a clinical classification system to identify pediatric thyroid cancer patients at risk for persistent/recurrent disease. Material and Methods We retrospectively included all patients in our registry diagnosed with papillary DTC at ≤ 18 years of age. We analyzed the prognostic performance of the ATA classification and other risk factors for predicting response to initial treatment and final outcome in pediatric DTC. Results We included 41 patients, 34 females and 7 males, diagnosed with papillary DTC at a mean (SD) age of 16.2 (1.8) years. Based on the ATA pediatric risk classification, patients were categorized as low (61%), intermediate (10%), or high risk (29%). The median follow-up period was 7.3 (1-41) years. After initial treatment, disease free status was achieved in 92%, 50%, and 42% of the low, intermediate, and high risk groups, respectively (P <0.01). At the last visit, persistent disease was present in 12%, 25%, and 33% (P=0.27). Assessing other risk factors, only the presence of distant metastases at diagnosis resulted in increased presence of persistent disease at last follow-up (P=0.03). Conclusion This study supports the clinical relevance of the ATA risk classification for predicting the response to initial treatment. There was no clear prediction of long-term outcome, but this may be due to limited power caused by the small number of patients.
Collapse
|
28
|
Galuppini F, Vianello F, Censi S, Barollo S, Bertazza L, Carducci S, Colato C, Manso J, Rugge M, Iacobone M, Watutantrige Fernando S, Pennelli G, Mian C. Differentiated Thyroid Carcinoma in Pediatric Age: Genetic and Clinical Scenario. Front Endocrinol (Lausanne) 2019; 10:552. [PMID: 31456750 PMCID: PMC6698790 DOI: 10.3389/fendo.2019.00552] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/25/2019] [Indexed: 12/04/2022] Open
Abstract
Introduction: Follicular-derived differentiated thyroid carcinoma (DTC) is the most common endocrine and epithelial malignancy in children. The differences in the clinical and pathological features of pediatric vs. adult DTC could relate to a different genetic profile. Few studies are currently available in this issue, however, and most of them involved a limited number of patients and focused mainly on radiation-exposed populations. Materials and Methods: We considered 59 pediatric patients who underwent surgery for DTC between 2000 and 2017. RET/PTC rearrangement was investigated with fluorescent in situ hybridization and real-time polymerase chain reaction. Sequencing was used to analyze mutations in the BRAF, NRAS, PTEN, PIK3CA genes, and the TERT promoter. The pediatric patients' clinical and molecular features were compared with those of 178 adult patients. Results: In our pediatric sample, male gender and age <15 years coincided with more extensive disease and more frequent lymph node and distant metastases. Compared with adults, the pediatric patients were more likely to have lymph node and distant metastasis, and to need second treatments (p < 0.01). In all, 44% of the pediatric patients were found to carry molecular alterations. RET/PTC rearrangement was confirmed as the most frequent genetic alteration in childhood DTC (24.6%) and correlated with aggressive features. BRAFV600E was only identified in 16% of the pediatric DTCs, while NRASQ61R, NRASQ61K, and TERTC250T mutations were very rare. Conclusions: Pediatric DTC is more aggressive at diagnosis and more likely to recur than its adult counterpart. Unlike the adult disease, point mutations have no key genetic role.
Collapse
Affiliation(s)
- Francesca Galuppini
- Pathology Unit, Department of Medicine (DIMED), Padova University Hospital, Padova, Italy
- Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Federica Vianello
- Department of Radiotherapy, Istituto Oncologico del Veneto, IOV-IRCCS, Padova, Italy
| | - Simona Censi
- Endocrinology Unit, Department of Medicine (DIMED), Padova University Hospital, Padova, Italy
| | - Susi Barollo
- Endocrinology Unit, Department of Medicine (DIMED), Padova University Hospital, Padova, Italy
| | - Loris Bertazza
- Endocrinology Unit, Department of Medicine (DIMED), Padova University Hospital, Padova, Italy
| | - Sofia Carducci
- Endocrinology Unit, Department of Medicine (DIMED), Padova University Hospital, Padova, Italy
| | - Chiara Colato
- Pathology Section, Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Jacopo Manso
- Endocrinology Unit, Department of Medicine (DIMED), Padova University Hospital, Padova, Italy
| | - Massimo Rugge
- Pathology Unit, Department of Medicine (DIMED), Padova University Hospital, Padova, Italy
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), Padova University Hospital, Padova, Italy
| | | | - Gianmaria Pennelli
- Pathology Unit, Department of Medicine (DIMED), Padova University Hospital, Padova, Italy
| | - Caterina Mian
- Endocrinology Unit, Department of Medicine (DIMED), Padova University Hospital, Padova, Italy
- *Correspondence: Caterina Mian
| |
Collapse
|
29
|
Bhavani N, Bhadran K, Nair V, Menon UV, Pavithran PV, Menon AS, Abraham N, Pankaj A, Kumar H. Treatment outcomes in pediatric differentiated thyroid carcinoma. J Pediatr Endocrinol Metab 2018; 31:1117-1122. [PMID: 30157034 DOI: 10.1515/jpem-2018-0233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/13/2018] [Indexed: 01/01/2023]
Abstract
Background Until the American Thyroid Association (ATA) guidelines on management of pediatric differentiated thyroid carcinoma (DTC) became available in 2015, all children with DTC were treated like adults. This study aims to investigate the outcome of pediatric DTC and factors predicting the response to therapy in pediatric DTC managed according to adult guidelines. Methods Clinical records of 41 children less than 18 years of age diagnosed with DTC followed from 2007 in a single center were reviewed. According to the new ATA classification for pediatric DTC, five had low-risk, 28 had intermediate-risk and eight had high-risk disease at presentation. Results There was no mortality or recurrence in this cohort of pediatric DTC patients and the cure rate was 46% during a mean follow-up of 44 months when they were managed according to adult guidelines. Neither the new ATA risk classification nor any clinicopathological character was identified which could predict the response to therapy. The new ATA guidelines would have avoided 27% of the radioiodine therapies given. Conclusions This study showed that DTC in children managed according to adult guidelines had a good cure rate. The new ATA guidelines on pediatric DTC might have drastically reduced the number of radioiodine therapies in the affected children. Long term prospective studies are needed to validate the benefits and risks of both these approaches.
Collapse
Affiliation(s)
- Nisha Bhavani
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala, India
| | - Kingini Bhadran
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala, India
| | - Vasantha Nair
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala, India
| | - Usha V Menon
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala, India
| | - Praveen V Pavithran
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala, India
| | - Arun S Menon
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala, India
| | - Nithya Abraham
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala, India
| | - Aswin Pankaj
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala, India
| | - Harish Kumar
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala, India
| |
Collapse
|
30
|
Zhang XY, Song HJ, Qiu ZL, Shen CT, Chen XY, Sun ZK, Wei WJ, Zhang GQ, Luo QY. Pulmonary metastases in children and adolescents with papillary thyroid cancer in China: prognostic factors and outcomes from treatment with 131I. Endocrine 2018; 62:149-158. [PMID: 30022382 DOI: 10.1007/s12020-018-1678-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/03/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE Papillary thyroid carcinoma (PTC) with pulmonary metastases is rare in children and adolescents. Unlike adults, limited data are available on children with this disease. Thus, this study evaluated the therapeutic efficacy and prognostic factors of individuals less than 21 years of age with pulmonary metastases from PTC. METHODS Seventy-six children and adolescents with pulmonary metastases from PTC treated with 131I were retrospectively analyzed. Therapeutic efficacy was evaluated by changes in serum thyroglobulin (Tg) and chest computed tomography (CT). Factors predictive of progression-free survival and overall survival were measured by the Kaplan-Meier method. RESULTS Among the 76 patients included in this study, 22.4% (17 of 76) were less than 15 years old and 65.8% (50 of 76) were female. Under the evaluation of stimulated serum Tg levels, RAI treatment were effective in 55.9% (38 of 68), stable in 26.5% (18 of 68) and ineffectvie in 17.6% (12 of 68) of patients. Changes on anatomical imaging suggested complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) in 8.5, 62.0, 15.5, and 14.1% of individuals, respectively. Univariate analysis showed that size and tumor doubling time of pulmonary metastases were independent factors affecting therapeutic efficacy. Extra-thyroidal extension, tumor diameter of pulmonary metastases and tumor doubling time were significant independent factors regarding progression-free survival rates, while only tumor doubling time and tumor diameter were significant risk factors associated with overall survival rate. CONCLUSIONS Radioactive iodine therapy is an effective treatment for children and adolescents with pulmonary metastases from PTC. Extra-thyroid extension was associated with disease progression while did not show significant influence on overall survival. Tumor doubling time and tumor diameter were the main factors influencing both progression-free survival and overall survival.
Collapse
Affiliation(s)
- Xin-Yun Zhang
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Hong-Jun Song
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Zhong-Ling Qiu
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China.
| | - Chen-Tian Shen
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Xiao-Yue Chen
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Zhen-Kui Sun
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Wei-Jun Wei
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Guo-Qiang Zhang
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Quan-Yong Luo
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China.
| |
Collapse
|
31
|
Kim K, Kim WW, Choi JB, Kim MJ, Lee CR, Lee J, Kang SW, Nam KH, Chung WY, Jeong JJ. Usefulness of dynamic risk stratification in pediatric patients with differentiated thyroid carcinoma. Ann Surg Treat Res 2018; 95:222-229. [PMID: 30310805 PMCID: PMC6172353 DOI: 10.4174/astr.2018.95.4.222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/19/2018] [Accepted: 03/14/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose Recently, the American Thyroid Association (ATA) dynamic risk stratification (DRS) has been verified to be more valuable than the static anatomical staging system for predicting prognosis in patients with differentiated thyroid carcinoma (DTC). The purpose of this retrospective study was to compare the clinical usefulness of DRS, which is based on the response to initial treatment, with that of ATA initial risk stratification in pediatric patients. Methods A total of 144 pediatric patients underwent thyroid operation from August 1982 to December 2013 at Yonsei University Hospital (Seoul, Korea). Among them, 128 patients with complete clinical data were enrolled in this study. Clinicopathologic features and surgical outcomes were retrospectively analyzed by medical chart review. The mean follow-up duration was 11.5 years. Results The mean tumor size was 2.1 cm; 80.4% of patients were diagnosed with conventional papillary thyroid carcinoma, and 7.0% of patients were diagnosed with follicular thyroid carcinoma. Low-risk patients had the highest probability of an excellent response to initial treatment (66.6%). High-risk patients had the highest probability of a structural incomplete response (100%) and the lowest probability of an excellent response (11.1%). The ATA risk stratification and the DRS system were independent risk factors for disease-free survival (DFS) (P = 0.041 and P < 0.001, respectively). Conclusion The DRS system, which is based on the response to initial treatment, can offer more useful prognostic information compared with ATA risk stratification in pediatric patients with DTC.
Collapse
Affiliation(s)
- Kwangsoon Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Won Woong Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Bum Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jhi Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Cho Rok Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jandee Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Wook Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kee-Hyun Nam
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Youn Chung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Ju Jeong
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
32
|
Russo M, Malandrino P, Moleti M, Vermiglio F, D'Angelo A, La Rosa G, Sapuppo G, Calaciura F, Regalbuto C, Belfiore A, Vigneri R, Pellegriti G. Differentiated thyroid cancer in children: Heterogeneity of predictive risk factors. Pediatr Blood Cancer 2018; 65:e27226. [PMID: 29768715 DOI: 10.1002/pbc.27226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/17/2018] [Accepted: 03/27/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To correlate clinical and pathological characteristics at diagnosis with patient long-term outcomes and to evaluate ongoing risk stratifications in a large series of paediatric differentiated thyroid cancers (DTC). STUDY DESIGN Retrospective analysis of clinical and pathological prognostic factors of 124 paediatric patients with DTC (age at diagnosis <19 years) followed up for 10.4 ± 8.4 years. Patients with a follow-up >3 years (n = 104) were re-classified 18 months after surgery on the basis of their response to therapy (ongoing risk stratification). RESULTS Most patients had a papillary histotype (96.0%), were older than 15 years (75.0%) and were diagnosed because of clinical local symptoms (63.7%). Persistent/recurrent disease was present in 31.5% of cases during follow-up, but at the last evaluation, only 12.9% had biochemical or structural disease. The presence of metastases in the lymph nodes of the lateral compartment (OR 3.2, 95% CI, 1.28-7.16, P = 0.01) was the only independent factor associated with recurrent/persistent disease during follow-up. At the last evaluation, biochemical/structural disease was associated with node metastases (N1a, N1b) by univariate but not multivariate analysis. Ongoing risk stratification compared to the initial risk classification method better identified patients with a lower probability of persistent/recurrent disease (NPV = 100%). CONCLUSIONS In spite of the aggressive presentations at diagnosis, paediatric patients with DTC show an excellent response to treatment and often a favourable outcome. N1b status should be considered a strong predictor of persistent/recurrent disease which, as in adults, is better predicted by ongoing risk stratification.
Collapse
Affiliation(s)
- Marco Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Pasqualino Malandrino
- Endocrinology Division, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Mariacarla Moleti
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Vermiglio
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio D'Angelo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuliana La Rosa
- Endocrinology Division, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Giulia Sapuppo
- Endocrinology Division, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Francesca Calaciura
- Endocrinology Division, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Concetto Regalbuto
- Endocrinology Division, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Antonino Belfiore
- Endocrinology Division, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Riccardo Vigneri
- Endocrinology Division, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy.,Institute of Biostructure and Bioimaging, National Research Council, Catania, Italy
| | - Gabriella Pellegriti
- Endocrinology Division, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| |
Collapse
|
33
|
Liu L, Huang F, Liu B, Huang R. Detection of distant metastasis at the time of ablation in children with differentiated thyroid cancer: the value of pre-ablation stimulated thyroglobulin. J Pediatr Endocrinol Metab 2018; 31:751-756. [PMID: 29953410 DOI: 10.1515/jpem-2018-0075] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/14/2018] [Indexed: 02/05/2023]
Abstract
Background The present study was designed to determine the value of pre-ablation stimulated thyroglobulin (s-Tg) in predicting distant metastasis (DM) at the time of ablation in children with differentiated thyroid cancer. Methods From August 2009 to December 2016, consecutive children with differentiated thyroid cancer undergoing remnant ablation were retrospectively analyzed. Serum s-Tg was measured with the high-sensitive electrochemiluminescence immunoassay during hypothyroidism at ablation just before the ablative radioactive iodine (131I) administration. Post-ablation, whole body planar scintigraphy was obtained 5 days after administration of ablation activity of 131I. Single photon emission computed tomography/low-dose computed tomography (SPECT/CT) was added for children whose planar findings were inconclusive. Receiver-operating characteristics (ROC) curve analysis was employed to find a cut-off level of pre-ablation s-Tg as a predictor of DM at the time of ablation. Results Fifty-seven children were included for the analysis. Metastases were noticed on post-ablation scintigraphy in 20 (35%) children: five post-operative residual neck lymph node metastases, four post-operative residual neck lymph node and lung metastases, three mediastinal lymph node and lung metastases and eight lung metastases. A significant difference in pre-ablation s-Tg levels was found in children with DM compared with those without DM, 603.5 vs. 5.7 ng/mL, respectively. A pre-ablation s-Tg level of 156 ng/mL was established as the optimal cut-off point to predict DM. Conclusions This study demonstrated that pre-ablation s-Tg could potentially act as a predictor of DM at the time of ablation in children with differentiated thyroid cancer. We also propose a specific pre-ablation s-Tg cut-off value of 156 ng/mL as an optimal threshold for practical use.
Collapse
Affiliation(s)
- Lina Liu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Fang Huang
- Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Bin Liu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Rui Huang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, P.R. China
| |
Collapse
|
34
|
Kim H, Kim HI, Kim SW, Jung J, Jeon MJ, Kim WG, Kim TY, Kim HK, Kang HC, Han JM, Cho YY, Kim TH, Chung JH. Prognosis of Differentiated Thyroid Carcinoma with Initial Distant Metastasis: A Multicenter Study in Korea. Endocrinol Metab (Seoul) 2018; 33:287-295. [PMID: 29947184 PMCID: PMC6021319 DOI: 10.3803/enm.2018.33.2.287] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/03/2018] [Accepted: 05/10/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Most patients with differentiated thyroid cancer (DTC) have a favorable prognosis. However, patients with DTC and initial distant metastasis have not been commonly found, and their clinical characteristics have seldom been reported. In this study, we analyzed the clinical features and prognosis of patients with DTC and initial distant metastasis in Korea. METHODS We retrospectively reviewed the clinical data of 242 patients with DTC and initial distant metastasis treated from 1994 to 2013, collected from five tertiary hospitals in Korea. RESULTS The patients' median age was 51 years, and 65% were women. They were followed for a median of 7 years. Lung was the most common site of distant metastasis: only lung 149 patients (62%), only bone 49 (20%), other single site one (pleura), and combined sites 43 (40 were lung and bone, two were bone and other site, and one was lung and other site). At the time of diagnosis, 50 patients (21%) had non-radioactive iodine (RAI) avidity. Five-year disease-specific survival (DSS) was 85% and 10-year DSS was 68%, which were better than those in previous studies. After multivariate analysis, old age, male sex, metastatic site, and histologic type (follicular type) were significant factors for poor prognosis. However, negative RAI avidity status was not a significant prognostic factor after adjusting for other variables. CONCLUSION The prognosis of Korean patients with DTC and initial distant metastasis was better than in previous studies. Old age, male sex, metastasis site, and histologic type were significant prognostic factors.
Collapse
Affiliation(s)
- Hosu Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Endocrinology, Department of Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Hye In Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaehoon Jung
- Division of Endocrinology, Department of Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Cheol Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Min Han
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Yoon Young Cho
- Division of Endocrinology and Metabolism, Department of Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
35
|
Jeon MJ, Kim YN, Sung TY, Hong SJ, Cho YY, Kim TY, Shong YK, Kim WB, Kim SW, Chung JH, Kim TH, Kim WG. Practical Initial Risk Stratification Based on Lymph Node Metastases in Pediatric and Adolescent Differentiated Thyroid Cancer. Thyroid 2018; 28:193-200. [PMID: 29179646 DOI: 10.1089/thy.2017.0214] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Data on the risk stratification of pediatric differentiated thyroid cancer (DTC) remain scarce. This study aimed to evaluate the predictors of structural persistent/recurrent disease and revise an initial risk-stratification system in pediatric DTC patients. METHODS This retrospective cohort study included 203 patients (aged <20 years) from two tertiary referral centers in Korea. The extent of cervical lymph node (LN) metastasis was classified based on the location or number of metastatic LNs. RESULTS During a median follow-up duration of 5.5 years, structural persistent/recurrent disease was observed in 51 (25%) patients, including 22 (11%) with distant metastases. The presence of extrathyroidal extension (ETE) and lateral cervical LN metastases or more than five metastatic LNs were independent predictors for structural persistent/recurrent disease. The presence of bilateral lateral cervical LN metastases or >10 metastatic LNs were independent predictors for distant metastasis. A total of 67 (33%), 72 (35%), and 64 (32%) patients were classified into the low-, intermediate-, and high-risk groups, respectively, based on the presence of ETE and the extent of cervical LN metastases. Compared to the low-risk group, the intermediate- and high-risk groups had a significantly greater risk of structural persistent/recurrent disease (hazard ratio = 7.32, p = 0.008, and hazard ratio = 24.28, p < 0.001, respectively). CONCLUSIONS This revised initial risk-stratification system based on the presence of ETE and the extent of cervical LN metastasis is useful for predicting the clinical outcomes of pediatric DTC patients. The findings could facilitate the practical use of a risk-stratification system.
Collapse
Affiliation(s)
- Min Ji Jeon
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Young Nam Kim
- 2 Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Tae-Yong Sung
- 3 Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Suck Joon Hong
- 3 Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Yoon Young Cho
- 4 Division of Endocrinology and Metabolism, Department of Medicine, Gyeongsang National University School of Medicine , Jinju, Korea
| | - Tae Yong Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Young Kee Shong
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Won Bae Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Sun Wook Kim
- 2 Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Jae Hoon Chung
- 2 Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Tae Hyuk Kim
- 2 Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Won Gu Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| |
Collapse
|
36
|
Lauretta R, Sansone M, Sansone A, Romanelli F, Appetecchia M. Gender in Endocrine Diseases: Role of Sex Gonadal Hormones. Int J Endocrinol 2018; 2018:4847376. [PMID: 30420884 PMCID: PMC6215564 DOI: 10.1155/2018/4847376] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/08/2018] [Accepted: 10/03/2018] [Indexed: 12/15/2022] Open
Abstract
Gender- and sex- related differences represent a new frontier towards patient-tailored medicine, taking into account that theoretically every medical specialty can be influenced by both of them. Sex hormones define the differences between males and females, and the different endocrine environment promoted by estrogens, progesterone, testosterone, and their precursors might influence both human physiology and pathophysiology. With the term Gender we refer, instead, to behaviors, roles, expectations, and activities carried out by the individual in society. In other words, "gender" refers to a sociocultural sphere of the individual, whereas "sex" only defines the biological sex. In the last decade, increasing attention has been paid to understand the influence that gender can have on both the human physiology and pathogenesis of diseases. Even the clinical response to therapy may be influenced by sex hormones and gender, but further research is needed to investigate and clarify how they can affect the human pathophysiology. The path to a tailored medicine in which every patient is able to receive early diagnosis, risk assessments, and optimal treatments cannot exclude the importance of gender. In this review, we have focused our attention on the involvement of sex hormones and gender on different endocrine diseases.
Collapse
Affiliation(s)
- R. Lauretta
- IRCCS Regina Elena National Cancer Institute, Endocrinology Unit, Rome, Italy
| | - M. Sansone
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza Università di Roma, Rome, Italy
| | - A. Sansone
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza Università di Roma, Rome, Italy
| | - F. Romanelli
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza Università di Roma, Rome, Italy
| | - M. Appetecchia
- IRCCS Regina Elena National Cancer Institute, Endocrinology Unit, Rome, Italy
| |
Collapse
|
37
|
Yan HX, Pang P, Wang FL, Tian W, Luo YK, Huang W, Yang GQ, Jin N, Zang L, Du J, Ba JM, Dou JT, Mu YM, Lyu ZH. Dynamic profile of differentiated thyroid cancer in male and female patients with thyroidectomy during 2000-2013 in China: a retrospective study. Sci Rep 2017; 7:15832. [PMID: 29158505 PMCID: PMC5696456 DOI: 10.1038/s41598-017-14963-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/19/2017] [Indexed: 12/23/2022] Open
Abstract
The study aimed to investigate the gender-related differences of disease onset, age distribution, blood type, clinical characteristics, and malignant behaviors of differentiated thyroid carcinoma (DTC) in Chinese patients. A total of 7385 consecutive thyroid cancer patients who underwent thyroidectomy were retrospectively reviewed. 4087 (55.3%) were diagnosed as benign and the other (3298, 44.7%) were as malignant. DTC accounted for 97.6% in the malignant tumor. More single nodules turned out to be DTC in male compared to multiple nodules (46.9% vs. 40.4%, P = 0.004). The proportion increased along with the increase of year during 2000–2013, which was from 7.5% to 68.1% in males and from 16.2% to 66.7% in females. The level of preoperative TSH was significantly higher in patients with DTC compared to the patients with benign (1.97 vs. 1.57 mIU/L, P < 0.001). The proportion of thyroid cancer was dominated in blood type B and the lowest incidence in blood type A in male, the difference was not statistically significant. The results showed that age, nodule number, BMI and serum TSH were the related factors for DTC. More aggressive behaviors of DTC were observed in male patients, and more attention should be focused on the timely diagnosis and treatment of these patients.
Collapse
Affiliation(s)
- Hui-Xian Yan
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, 100853, China.,Beijing Haidian Hospital, Beijing Haidian Section of Peking University Third Hospital, Beijing, 100080, China
| | - Ping Pang
- Department of Endocrinology, Hainan Branch of PLA General Hospital, Sanya, 572013, Hainan, China
| | - Fu-Lin Wang
- Department of Pathology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Wen Tian
- Department of General Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yu-Kun Luo
- Department of Ultrasonography, Chinese PLA General Hospital, Beijing, 100853, China
| | - Wei Huang
- Beijing Haidian Hospital, Beijing Haidian Section of Peking University Third Hospital, Beijing, 100080, China
| | - Guo-Qing Yang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Nan Jin
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Li Zang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jin Du
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jian-Ming Ba
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jing-Tao Dou
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yi-Ming Mu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhao-Hui Lyu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, 100853, China.
| |
Collapse
|
38
|
Sohn SY, Kim YN, Kim HI, Kim TH, Kim SW, Chung JH. Validation of dynamic risk stratification in pediatric differentiated thyroid cancer. Endocrine 2017; 58:167-175. [PMID: 28822062 DOI: 10.1007/s12020-017-1381-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/21/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE There has been increasing interest in a risk-adopted management strategy known as dynamic risk stratification following the revised American Thyroid Association guidelines for differentiated thyroid cancer. We aimed to evaluate the usefulness of dynamic risk stratification for predicting structural disease in pediatric differentiated thyroid cancer patients. METHODS We retrospectively reviewed 130 pediatric differentiated thyroid cancer patients (≤19 years) who were treated between 1996 and 2015 at Samsung Medical Center. Patients were stratified according to three American Thyroid Association initial risk group (low, intermediate, or high risk) and four dynamic risk stratification group (excellent, indeterminate, biochemical incomplete, or structural incomplete). RESULTS Based on dynamic risk stratification strategy, structural disease was identified 3.9% in the excellent group, 9.7% in the indeterminate group, 76.9% in the biochemical incomplete group, and 100% in the structural incomplete group. The hazard ratios of the structural disease were 18.10 (P < 0.001) in the biochemical incomplete group, and 19.583 (P < 0.001) in the structural incomplete group compared to the excellent group. The prevalence of structural disease also increased as American Thyroid Association initial risk classification increased (5.9% in the low-risk group, 13.6% in the intermediate-risk group, and 45% in the high-risk group). The hazard ratios of structural disease in the high-risk group was 10.296 (P < 0.001) in compared to the low-risk group. CONCLUSION Dynamic risk stratification based on patient responses to initial therapy was able to effectively predict the risk of structural disease in a pediatric population, and as a follow-up strategy, may work as well in pediatric differentiated thyroid cancer patients as it does in adult differentiated thyroid cancer patients.
Collapse
Affiliation(s)
- Seo Young Sohn
- Department of Endocrinology and Metabolism, Seonam University, Myongji Hospital, Goyang, Korea
| | - Young Nam Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye In Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
39
|
Wassner AJ, Della Vecchia M, Jarolim P, Feldman HA, Huang SA. Prevalence and Significance of Thyroglobulin Antibodies in Pediatric Thyroid Cancer. J Clin Endocrinol Metab 2017; 102:3146-3153. [PMID: 28398507 PMCID: PMC6283415 DOI: 10.1210/jc.2017-00286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/05/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Circulating thyroglobulin antibodies (TgAb) can confound measurement of serum thyroglobulin and impair thyroid cancer surveillance. Few data exist on the significance of TgAb in pediatric thyroid cancer. OBJECTIVE To describe the prevalence, natural history, and clinical significance of TgAb in children with thyroid cancer. DESIGN Retrospective cohort study. SETTING Single academic pediatric center. PATIENTS Seventy-three consecutive children (≤18 years) with nonmedullary thyroid cancer who had serum TgAb measured within 6 months after diagnosis. MAIN OUTCOME MEASURES Prevalence and natural history of TgAb; association of TgAb status and resolution with patient and disease characteristics. RESULTS TgAb were detected in 41% of subjects (30 of 73) and were associated with lymph node metastasis (83% vs 53%, P = 0.01) but not distant metastasis. In patients with TgAb, resolution occurred in 44% (11 of 25) over a median follow-up of 3.8 years. Median time to clear TgAb was 10.7 months, and 10 of 11 patients who cleared (91%) did so within 2 years. Resolution of TgAb was associated with lower initial TgAb level (median 4.5 vs 76 normalized units, P = 0.003). TgAb positivity at diagnosis was not independently associated with persistent or recurrent disease (odds ratio 3.20, 95% confidence interval 0.95 to 10.80, P = 0.06). CONCLUSIONS TgAb are common at diagnosis in children with thyroid cancer but resolve in nearly half of patients within 1 to 2 years. TgAb are associated with the presence of lymph node metastasis at diagnosis, but the long-term prognostic significance remains to be determined.
Collapse
Affiliation(s)
- Ari J Wassner
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts 02115
| | | | - Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115
| | - Henry A Feldman
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts 02115
| | - Stephen A Huang
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts 02115
- Address all correspondence and requests for reprints to: Stephen A. Huang, MD, Division of Endocrinology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115. E-mail:
| |
Collapse
|
40
|
Kim H, Kim TH, Choe JH, Kim JH, Kim JS, Oh YL, Hahn SY, Shin JH, Chi SA, Jung SH, Kim YN, Kim HI, Kim SW, Chung JH. Patterns of Initial Recurrence in Completely Resected Papillary Thyroid Carcinoma. Thyroid 2017; 27:908-914. [PMID: 28446060 DOI: 10.1089/thy.2016.0648] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Despite improvements in the surgical and medical treatment of papillary thyroid carcinoma (PTC), subsets of patients suffer from structural recurrence after initial treatment. This study evaluated the timing and patterns of recurrence in completely resected PTC patients. METHODS A retrospective review of a prospectively maintained thyroid cancer database was performed. The timing and patterns of recurrence were reviewed in 2250 patients with PTC >1 cm who achieved complete remission after total thyroidectomy and/or radioactive iodine treatment. Univariate and multivariate analyses were performed to identify factors predictive of recurrence patterns. RESULTS During 8.1 years of mean follow-up, 68 (3.0%) patients developed structural recurrences: 53 lymph node recurrences (LNR), 11 local soft tissue recurrences (LR), and four distant recurrences (DR). Two patients died of DR. Younger patients had a higher proportion of LNR, and older patients had a tendency toward LR/DR. LNR showed a peak incidence between one and three years after remission, but LR/DR showed a delayed peak incidence between two and four years. The factors that significantly increased the risk of LNR were multifocal tumor and lymph node metastasis (central/lateral). The factors that increased the risk of LR/DR were old age, large tumor size (>2 cm), and lateral lymph node metastasis. In addition, central neck dissection significantly reduced subsequent LR/DR. CONCLUSION Patterns of recurrence after complete PTC resection are variable and associated with specific clinicopathologic factors. Understanding the timing and patterns of recurrence may lead to more effective adjuvant treatment and improved long-term follow-up strategies.
Collapse
Affiliation(s)
- Hosu Kim
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
- 2 Division of Endocrinology, Department of Medicine, Gyeongsang National University Changwon Hospital , Changwon. Korea
| | - Tae Hyuk Kim
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Jun-Ho Choe
- 3 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Jung-Han Kim
- 3 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Jee Soo Kim
- 3 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Young Lyun Oh
- 4 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Soo Yeon Hahn
- 5 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Jung Hee Shin
- 5 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Sang Ah Chi
- 6 Department of Statics and Data Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Sin-Ho Jung
- 7 Department of Biostatistics and Bioinformatics, Duke University , Durham, North Carolina
| | - Young Nam Kim
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Hye In Kim
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Sun Wook Kim
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Jae Hoon Chung
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| |
Collapse
|
41
|
Zanella A, Scheffel RS, Pasa MW, Dora JM, Maia AL. Role of Postoperative Stimulated Thyroglobulin as Prognostic Factor for Differentiated Thyroid Cancer in Children and Adolescents. Thyroid 2017; 27:787-792. [PMID: 28292215 DOI: 10.1089/thy.2016.0559] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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%. CONCLUSION The data demonstrate that sPOTg displayed high accuracy in predicting the risk of persistent disease in young patients with DTC.
Collapse
Affiliation(s)
- André Zanella
- Thyroid Section, Endocrine Division, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul , Porto Alegre, Brazil
| | - Rafael Selbach Scheffel
- Thyroid Section, Endocrine Division, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul , Porto Alegre, Brazil
| | - Marina Weber Pasa
- Thyroid Section, Endocrine Division, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul , Porto Alegre, Brazil
| | - José Miguel Dora
- Thyroid Section, Endocrine Division, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul , Porto Alegre, Brazil
| | - Ana Luiza Maia
- Thyroid Section, Endocrine Division, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul , Porto Alegre, Brazil
| |
Collapse
|