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Endocrine
Published in: Endocrine 3/2020

01-12-2020 | Metastasis | Original Article

Long-term outcome of differentiated thyroid cancer in children and young adults: risk stratification by ATA criteria and assessment of pre-ablation stimulated thyroglobulin as predictors of disease persistence

Authors: Olga Karapanou, Marinella Tzanela, Phoebe Rondogianni, Catherine Dacou-Voutetakis, Dimitrios Chiotis, Barbara Vlassopoulou, Dimitra Vassiliadi, Christina Kanaka-Gantenbein, Stylianos Tsagarakis

Published in: Endocrine | Issue 3/2020

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Abstract

Purpose

Differentiated thyroid cancer (DTC) has an increasing incidence in childhood and adolescence but long-term outcome data are limited. We aimed to identify possible risk factors associated with disease persistence, with special focus on the usefulness of ATA risk stratification system and pre-ablation stimulated thyroglobulin (Tg) levels.

Methods

We retrospectively studied 103 patients, 79 females (76.7%), aged 15.6 ± 3.2 years (range 5–21 years) who underwent total thyroidectomy for DTC. Patients were classified by ATA risk stratification criteria as low, intermediate, and high risk for recurrence. All, except five with papillary microcarcinoma, received radioactive iodine (RAI) treatment.

Results

At diagnosis, 44.7% of patients had cervical lymph node and 7.8% pulmonary metastases. Amongst the 72 patients with long-term follow-up data, 31.9% had persistent disease. Lymph node as well as pulmonary metastases and increased pre-ablation stimulated thyroglobulin (Tg) levels were associated with persistent disease. The risk of persistent disease was significantly higher in both the intermediate- (OR 17.95; 95% CI 2.66–120.94, p < 0.01) and high-risk (OR 17.65; 95% CI 4.47–69.74, p < 0.001) groups. ROC curve analysis showed that a pre-ablation Tg level higher than 14 ng/ml had a sensitivity of 94.7% to predict persistence, corresponding to a positive (PPV) and negative predictive values (NPV) of 66.7% and 93.8%, respectively.

Conclusions

ATA risk stratification was validated in our population of children and young adults with DTC. Moreover, pre-ablation stimulated Tg levels of <14 ng/ml were associated with a low risk of long-term persistence and may therefore serve as a marker to identify patients who may need less intensive surveillance.
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Metadata
Title
Long-term outcome of differentiated thyroid cancer in children and young adults: risk stratification by ATA criteria and assessment of pre-ablation stimulated thyroglobulin as predictors of disease persistence
Authors
Olga Karapanou
Marinella Tzanela
Phoebe Rondogianni
Catherine Dacou-Voutetakis
Dimitrios Chiotis
Barbara Vlassopoulou
Dimitra Vassiliadi
Christina Kanaka-Gantenbein
Stylianos Tsagarakis
Publication date
01-12-2020
Publisher
Springer US
Published in
Endocrine / Issue 3/2020
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-020-02378-2

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