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Differentiated thyroid cancer in children: Heterogeneity of predictive risk factors
Author(s) -
Russo Marco,
Malandrino Pasqualino,
Moleti Mariacarla,
Vermiglio Francesco,
D'Angelo Antonio,
Rosa Giuliana,
Sapuppo Giulia,
Calaciura Francesca,
Regalbuto Concetto,
Belfiore Antonino,
Vigneri Riccardo,
Pellegriti Gabriella
Publication year - 2018
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.27226
Subject(s) - medicine , pathological , disease , thyroid cancer , univariate analysis , retrospective cohort study , multivariate analysis , pediatrics , thyroid , lymph node , oncology
Objective To correlate clinical and pathological characteristics at diagnosis with patient long‐term outcomes and to evaluate ongoing risk stratifications in a large series of paediatric differentiated thyroid cancers (DTC). Study design Retrospective analysis of clinical and pathological prognostic factors of 124 paediatric patients with DTC (age at diagnosis <19 years) followed up for 10.4 ± 8.4 years. Patients with a follow‐up >3 years (n = 104) were re‐classified 18 months after surgery on the basis of their response to therapy (ongoing risk stratification). Results Most patients had a papillary histotype (96.0%), were older than 15 years (75.0%) and were diagnosed because of clinical local symptoms (63.7%). Persistent/recurrent disease was present in 31.5% of cases during follow‐up, but at the last evaluation, only 12.9% had biochemical or structural disease. The presence of metastases in the lymph nodes of the lateral compartment (OR 3.2, 95% CI, 1.28–7.16, P = 0.01) was the only independent factor associated with recurrent/persistent disease during follow‐up. At the last evaluation, biochemical/structural disease was associated with node metastases (N1a, N1b) by univariate but not multivariate analysis. Ongoing risk stratification compared to the initial risk classification method better identified patients with a lower probability of persistent/recurrent disease (NPV = 100%). Conclusions In spite of the aggressive presentations at diagnosis, paediatric patients with DTC show an excellent response to treatment and often a favourable outcome. N1b status should be considered a strong predictor of persistent/recurrent disease which, as in adults, is better predicted by ongoing risk stratification.