Age, American Thyroid Association Risk Group, and Response to Therapy Are Prognostic Factors in Children With Differentiated Thyroid Cancer
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Published on: June 9, 2023
Antje Redlich1, Markus Luster2, Kerstin Lorenz3
1Pediatric Oncology Department, Otto von Guericke University Children's Hospital, Magdeburg, Germany.
Insights
Pediatric differentiated thyroid carcinoma (DTC) often presents advanced, but prognosis is excellent. Age, American Thyroid Association (ATA) risk group, and treatment response significantly impact event-free survival (EFS) in pediatric DTC patients.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Cancer Research
Background:
- Pediatric differentiated thyroid carcinoma (DTC) presents with increasing incidence, often at advanced stages with high recurrence rates.
- Despite advanced presentation, pediatric DTC generally has an excellent prognosis.
- Current risk stratification and follow-up strategies require adaptation for pediatric DTC.
Purpose of the Study:
- To investigate the utility of a pediatric classification system for DTC.
- To evaluate the application of an adult response-to-therapy risk stratification in pediatric DTC.
- To determine the implications of these classifications for adapting treatment and follow-up protocols in pediatric DTC.
Main Methods:
- Analysis of data from pediatric DTC patients (<18 years) registered in the German Pediatric Oncology Hematology-Malignant Endocrine Tumor registry since 1995.
- Retrospective assignment of patients to American Thyroid Association (ATA) risk groups for risk prediction.
- Evaluation of patient response to therapy.
Main Results:
- 354 pediatric DTC patients were analyzed (median age 13.7 years), with 74.3% having lymph node and 24.5% distant metastases.
- Ten-year overall survival was 98.9%, and event-free survival (EFS) was 78.1%.
- Factors significantly impairing EFS included lymph node/distant metastases, positive postoperative thyroglobulin, incomplete resection, capsule/lymph vessel invasion, soft tissue infiltration, multifocality, ATA intermediate/high-risk groups, and age <10 years. Multivariate analysis identified age <10 years, ATA high-risk level, and poor response to therapy as negative prognostic factors for EFS.
Conclusions:
- Age at diagnosis, ATA risk group, and response to therapy are significant prognostic factors for EFS in pediatric DTC.
- These findings necessitate a risk-adapted, individualized approach to therapy and follow-up for pediatric DTC patients.
- The study highlights the importance of tailored management strategies based on identified prognostic indicators.
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.
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