Prognostic factors for early and long-term remission in pediatric differentiated thyroid cancer: the role of gender, age, clinical presentation and the newly proposed American Thyroid Association risk stratification system.

Prognostic factors for early and long-term remission in pediatric differentiated thyroid cancer: the role of gender, age, clinical presentation and the newly proposed American Thyroid Association risk stratification system.

Thyroid. 2016 Aug 19;

Authors: Pires B, Alves-Junior PA, Bordallo MA, Bulzico DA, Coeli CM, de Oliveira RV, Santos IC, Farias T, Dias FL, Lima RA, Lopes F, Corbo R, Vaisman M, Vaisman F

Abstract
BACKGROUND: The incidence of pediatric differentiated thyroid carcinoma (DTC) has been rising in recent years, and the main risk factors for recurrence are lymph node and distant metastasis at diagnosis. Other clinical features remain unclear, such as the impact of age, gender and puberty. Furthermore, until now, this population has been treated using the same strategies used to treat adults. In 2015, the American Thyroid Association (ATA) published the first guidelines targeted to this age group. The aim of this study is to investigate the prognostic factors for early and long-term remission and also validate the ATA risk stratification proposal in a population outside the US.
METHODS: Clinical records from 118 patients <18 years old followed in two referral centers were reviewed.
RESULTS: The median age was 12 (4-18) years, and 20.3% (24 patients) were less than 10 years old at diagnosis, with a median follow-up of 9.1 years. The majority were female (72%), received total thyroidectomy and radioiodine therapy (RAI), and 61.8% underwent more than one dose of RAI. The majority were classified as high risk (48.3%) by the new ATA pediatric guidelines due to distant metastasis (30 patients) or extensive lymph node involvement (27 patients), followed by low risk (31.3%) and intermediate (20.4%). Females with no lymph node or distant metastasis and low ATA pediatric risk were more likely to have no evidence of disease (p<0.05) within the first year and also in the long term. In our study, age did not significantly predict outcomes. Furthermore, patients also benefitted from multiple doses of RAI, but when the cumulative activity was above 400 mCi, this benefit was diminished.
CONCLUSIONS: This study showed that the ATA risk stratification proposal for pediatric patients is useful in predicting early and long-term outcomes in pediatric patients with DTC. In addition, we showed that gender and metastatic disease are important prognostic factors in pediatric populations.

PMID: 27540892 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2b7SG2g
via IFTTT