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Risk stratification and long-term monitoring in pediatric thyroid cancer: predictive markers for disease persistence
Mariana Mazeu Barbosa de Oliveira1, Laura Sterian Ward2, Adriano Namo Cury1
1Faculdade de Ciências Médicas da Santa Casa de São Paulo Ringgold Standard Institution - Endocrinology, São Paulo, Brazil.
Insights
Early dynamic risk stratification accurately predicts long-term outcomes in pediatric differentiated thyroid carcinoma (DTC), outperforming initial risk stratification. Postoperative stimulated thyroglobulin (sPOTg) is a key biomarker for risk assessment in pediatric DTC patients.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Risk Stratification
Background:
- Managing pediatric differentiated thyroid carcinoma (DTC) requires effective risk stratification for treatment and follow-up.
- Current pediatric dynamic risk stratification lacks formal recommendations, unlike established adult protocols.
Purpose of the Study:
- To assess the prognostic value of early dynamic risk stratification (EDRS) and postoperative stimulated thyroglobulin (sPOTg) in pediatric DTC.
- To compare EDRS with the initial American Thyroid Association (ATA) pediatric risk stratification (IRS).
Main Methods:
- Retrospective cohort study of 123 pediatric DTC patients (≤18 years).
- Compared initial ATA risk stratification (IRS), early dynamic risk stratification (EDRS, 1-3 years post-treatment), and late dynamic response (LDRS, ≥10 years).
- Analyzed associations using chi-square, logistic regression, Cohen's Kappa, Cramér's V, and ROC curve analysis for sPOTg.
Main Results:
- EDRS strongly correlated with LDRS (Cramér's V = 0.829) and outperformed IRS (Cramér's V = 0.33) in 83 patients with ≥10 years follow-up.
- Substantial concordance (Kappa = 0.79) was observed between EDRS and LDRS.
- sPOTg demonstrated good predictive performance for disease persistence (AUCs 0.84 at 1-3 years, 0.81 at ≥10 years).
Conclusions:
- Early dynamic response is a robust predictor of long-term outcomes in pediatric DTC, potentially exceeding IRS accuracy.
- Postoperative stimulated thyroglobulin (sPOTg) serves as a valuable biomarker for both early and late risk assessment.
- Prospective multicenter studies are recommended to validate these findings.
Background:
Initial risk stratification and dynamic risk stratification are crucial in managing pediatric differentiated thyroid carcinoma (DTC), aiming to guide treatment and long-term follow-up. While adult dynamic stratification is well established, pediatric data remain limited, and no formal recommendations exist for its use.
Objective:
To evaluate the prognostic value of early dynamic risk stratification (EDRS) and postoperative stimulated thyroglobulin (sPOTg) in predicting long-term outcomes in pediatric DTC and to compare EDRS with initial ATA pediatric risk stratification (IRS).
Methods:
We conducted a retrospective cohort study of 123 patients ≤18 years with DTC treated at a tertiary center. IRS and EDRS (1-3 years post-treatment) were compared to late dynamic response (LDRS, ≥10 years post-treatment). A total of 83 patients had complete long-term follow-up data. Associations were assessed using chi-square tests, logistic regression, Cohen's kappa, and Cramér's V. ROC curve analysis evaluated the predictive value of sPOTg.
Results:
Among 83 patients with ≥10 years of follow-up, EDRS showed a strong association with LDRS (Cramér's V = 0.829; P < 0.001), outperforming IRS (Cramér's V = 0.33; P = 0.0029). Concordance between EDRS and LDRS was substantial (kappa = 0.79). Stimulated postoperative thyroglobulin (sPOTg) showed good discriminatory performance for disease persistence, with AUCs of 0.84 (95% CI: 0.70-0.95) at 1-3 years and 0.81 at ≥10 years.
Conclusion:
Early dynamic response is a strong predictor of long-term outcomes and may surpass IRS in prognostic accuracy. sPOTg is a valuable biomarker for both early and late risk assessment. Prospective multicenter validation is warranted.
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