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The Prognostic Power of Preablation Stimulated Thyroglobulin in Children With Differentiated Thyroid Cancer
Farnaz Nesari Javan1, Emran Askari1, Susan Shafiei1
1Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
Preablation stimulated thyroglobulin (psTg) levels predict treatment outcomes in pediatric differentiated thyroid carcinoma (DTC). Elevated psTg (≥ 13.75 ng/mL) is the strongest indicator of incomplete initial response and predicts distant metastases in children with DTC.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Nuclear Medicine
Background:
- Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy in children.
- Identifying prognostic factors is crucial for optimizing treatment strategies and improving outcomes in pediatric DTC patients.
- Long-term follow-up is essential for assessing treatment response and detecting recurrence.
Purpose of the Study:
- To identify prognostic factors influencing treatment outcomes in children with DTC.
- To analyze the predictive value of preablation stimulated thyroglobulin (psTg) levels.
- To evaluate the relationship between psTg levels and treatment response, including distant metastasis.
Main Methods:
- Retrospective analysis of 126 children (≤18 years) treated for DTC over 27 years.
- All patients underwent near-total thyroidectomy, radioiodine therapy, and thyroid hormone replacement.
- Follow-up included clinical evaluation and biochemical markers (psTg) according to American Thyroid Association guidelines.
Main Results:
- Papillary thyroid cancer predominated (93.7%); 52.4% had lymph node metastasis, and 8.8% had distant metastasis.
- Preablation stimulated thyroglobulin (psTg) levels were significantly higher in patients with incomplete first-year response (202.4 ng/mL vs. 11.2 ng/mL, P=.001).
- Logistic regression identified psTg as the sole significant predictor of distant metastasis, with psTg ≥ 13.75 ng/mL being the strongest predictor of incomplete initial response.
Conclusions:
- Preablation stimulated thyroglobulin (psTg) level is the most significant predictor of distant metastases in pediatric differentiated thyroid carcinoma.
- A psTg level ≥ 13.75 ng/mL is the most powerful indicator of an incomplete treatment response within the first year.
- These findings emphasize the importance of psTg monitoring for risk stratification and treatment management in children with DTC.
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.
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