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Prognostic value of 12-month response to therapy in pediatric patients with differentiated thyroid cancer
Emilia Zampella1, Leandra Piscopo1, Mariarosaria Manganelli1
1Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
Insights
The 12-month response to therapy in pediatric differentiated thyroid cancer (DTC) patients predicts outcomes. Patients showing no excellent response (no-ER) after radioactive iodine (RAI) therapy require close monitoring for disease recurrence.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Nuclear Medicine
Background:
- Differentiated thyroid cancer (DTC) is the most common endocrine malignancy in children.
- Initial risk stratification and early response assessment are crucial for managing pediatric DTC.
- Surgery and radioactive iodine (RAI) are standard initial treatments.
Purpose of the Study:
- To evaluate the prognostic significance of the 12-month therapeutic response in pediatric DTC patients.
- To determine if early treatment response predicts long-term outcomes after initial surgery and RAI therapy.
Main Methods:
- Retrospective analysis of 94 pediatric DTC patients treated with surgery and RAI.
- Risk stratification based on American Thyroid Association (ATA) guidelines.
- Assessment of 12-month response using serum thyroglobulin (Tg) and neck ultrasound, categorizing patients into excellent response (ER) or no-ER groups.
Main Results:
- 66% of patients achieved an excellent response (ER) at 12 months.
- Patients with no-ER had a significantly higher cumulative event rate (20%) during a mean follow-up of 86 months.
- No-ER was identified as the sole independent predictor of adverse events in multivariate analysis.
Conclusions:
- The 12-month response to therapy in pediatric DTC is an independent prognostic factor for mid-term outcomes.
- Pediatric DTC patients with no-ER at 12 months post-RAI therapy warrant close follow-up due to higher recurrence risk.
Purpose:
In pediatric patients with differentiated thyroid cancer (DTC) we assessed the prognostic value of the 12-month response to therapy after initial treatment with surgery and radioactive iodine (RAI).
Methods:
We retrospectively evaluated 94 pediatric patients with DTC, treated with surgery and RAI who were initially classified as low, intermediate or high risk of relapse of disease according to the American Thyroid Association (ATA) guidelines. Twelve months after RAI administration the response to therapy was assessed by serum thyroglobulin (Tg) measurement and neck ultrasound and patients were classified as having excellent response (ER) or no-ER.
Results:
At the 12 months evaluation, 62 (66%) patients had ER and 32 (34%) no-ER. During a mean follow-up time of 86 months (range 9-517), 19 events occurred (20% cumulative event rate). Events occurred more frequently in younger patients (p < 0.05), in those at ATA intermediate/high risk (p < 0.01) and with a pre-RAI therapy Tg level > 10 ng/mL (p < 0.001), and in those with no-ER (p < 0.001). At multivariate analysis, the evidence of no-ER was the only independent predictor of events.
Conclusion:
In pediatric patients with DTC, the response to therapy evaluated 12 months after initial treatment has an independent prognostic impact and is able to predict mid-term outcome. Patients with no-ER at 12 months after RAI therapy should be closely followed-up.
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