title: Pediatric Thyroid Cancer: Postoperative Classifications and Response to Initial Therapy as Prognostic Factors.
abstract: Prognostic factors for pediatric differentiated thyroid cancer (DTC) are not well established.
  
  
  
  The objective of the study was to retrospectively compare the postoperative risk-stratification systems: American Thyroid Association (ATA) risk categories, Schneider Children's Medical Center of Israel (SCMCI) score, and the response to initial therapy as predictors for disease outcome.
  
  
  
  Fifty-four DTC patients, median age at diagnosis 13.9 years (range 1.9-17 y), followed up for a median of 8.8 years (range 2.6-20.5 y) were stratified into prepubertal (n = 9), pubertal (n = 25), and postpubertal (n = 20) groups. All patients underwent total/near-total thyroidectomy; 48 received radioiodine therapy. The extent of DTC was evaluated by applying the ATA risk categories and the novel SCMCI score. Postoperative risk stratifications (low/intermediate/high) were determined using histopathological, laboratory, and imaging findings. Response to initial therapy (complete/acceptable/incomplete) was based on stimulated thyroglobulin and imaging results during the first 2 years of follow-up.
  
  
  
  The risk for recurrent/persistent disease, as assessed by the postoperative ATA risk-stratification system and the SCMCI score and by the response to initial therapy, was higher in the prepubertal group (P < .001, P = .002, and P = .02, respectively). Outcome prediction by the risk-stratification systems was applicable: ATA risk categories, P = .014, R(2) = 0.247, predictive ability 80.4%; SCMCI score, P < .001, R(2) = 0.435, predictive ability 86.3%; and response to initial therapy stratification, P < .001, R(2) = 0.789, predictive ability 96.1%. The proportion of variance explained by the ATA risk categories (0.25), SCMCI score (0.44), and response to initial therapy (0.79) indicated that the latter was the most precise predictor and that the SCMCI score reflected the disease outcome better than ATA risk categories.
  
  
  
  Our data confirm that the postoperative pediatric ATA stratification system and the novel SCMCI score are suitable for predicting the risk of recurrent/persistent disease in this population. The response to initial therapy classification performed 1-2 years after the initial therapy may be more appropriate for guiding surveillance recommendations.
authors.affiliation: The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes (L.L., Y.L., M.Y.-G., M.P.), Department of Pediatric Hematology-Oncology (I.Y.), Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel; Departments of Otolaryngology and Head and Neck Surgery (K.S.), Nuclear Medicine (A.S), and Imaging (M.C.), and Institute of Pathology (Y.S.), Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel; and Sackler Faculty of Medicine (L.L., Y.L., K.S., M.C., I.Y., M.P.) Tel Aviv University, Tel Aviv 69978, Israel.
authors.forename: Liora
authors.initials: L
authors.lastname: Lazar
authors.affiliation: The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes (L.L., Y.L., M.Y.-G., M.P.), Department of Pediatric Hematology-Oncology (I.Y.), Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel; Departments of Otolaryngology and Head and Neck Surgery (K.S.), Nuclear Medicine (A.S), and Imaging (M.C.), and Institute of Pathology (Y.S.), Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel; and Sackler Faculty of Medicine (L.L., Y.L., K.S., M.C., I.Y., M.P.) Tel Aviv University, Tel Aviv 69978, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Lebenthal
authors.affiliation: The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes (L.L., Y.L., M.Y.-G., M.P.), Department of Pediatric Hematology-Oncology (I.Y.), Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel; Departments of Otolaryngology and Head and Neck Surgery (K.S.), Nuclear Medicine (A.S), and Imaging (M.C.), and Institute of Pathology (Y.S.), Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel; and Sackler Faculty of Medicine (L.L., Y.L., K.S., M.C., I.Y., M.P.) Tel Aviv University, Tel Aviv 69978, Israel.
authors.forename: Karl
authors.initials: K
authors.lastname: Segal
authors.affiliation: The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes (L.L., Y.L., M.Y.-G., M.P.), Department of Pediatric Hematology-Oncology (I.Y.), Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel; Departments of Otolaryngology and Head and Neck Surgery (K.S.), Nuclear Medicine (A.S), and Imaging (M.C.), and Institute of Pathology (Y.S.), Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel; and Sackler Faculty of Medicine (L.L., Y.L., K.S., M.C., I.Y., M.P.) Tel Aviv University, Tel Aviv 69978, Israel.
authors.forename: Adam
authors.initials: A
authors.lastname: Steinmetz
authors.affiliation: The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes (L.L., Y.L., M.Y.-G., M.P.), Department of Pediatric Hematology-Oncology (I.Y.), Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel; Departments of Otolaryngology and Head and Neck Surgery (K.S.), Nuclear Medicine (A.S), and Imaging (M.C.), and Institute of Pathology (Y.S.), Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel; and Sackler Faculty of Medicine (L.L., Y.L., K.S., M.C., I.Y., M.P.) Tel Aviv University, Tel Aviv 69978, Israel.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Strenov
authors.affiliation: The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes (L.L., Y.L., M.Y.-G., M.P.), Department of Pediatric Hematology-Oncology (I.Y.), Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel; Departments of Otolaryngology and Head and Neck Surgery (K.S.), Nuclear Medicine (A.S), and Imaging (M.C.), and Institute of Pathology (Y.S.), Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel; and Sackler Faculty of Medicine (L.L., Y.L., K.S., M.C., I.Y., M.P.) Tel Aviv University, Tel Aviv 69978, Israel.
authors.forename: Maya
authors.initials: M
authors.lastname: Cohen
authors.affiliation: The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes (L.L., Y.L., M.Y.-G., M.P.), Department of Pediatric Hematology-Oncology (I.Y.), Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel; Departments of Otolaryngology and Head and Neck Surgery (K.S.), Nuclear Medicine (A.S), and Imaging (M.C.), and Institute of Pathology (Y.S.), Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel; and Sackler Faculty of Medicine (L.L., Y.L., K.S., M.C., I.Y., M.P.) Tel Aviv University, Tel Aviv 69978, Israel.
authors.forename: Isaac
authors.initials: I
authors.lastname: Yaniv
authors.affiliation: The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes (L.L., Y.L., M.Y.-G., M.P.), Department of Pediatric Hematology-Oncology (I.Y.), Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel; Departments of Otolaryngology and Head and Neck Surgery (K.S.), Nuclear Medicine (A.S), and Imaging (M.C.), and Institute of Pathology (Y.S.), Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel; and Sackler Faculty of Medicine (L.L., Y.L., K.S., M.C., I.Y., M.P.) Tel Aviv University, Tel Aviv 69978, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Yackobovitch-Gavan
authors.affiliation: The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes (L.L., Y.L., M.Y.-G., M.P.), Department of Pediatric Hematology-Oncology (I.Y.), Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel; Departments of Otolaryngology and Head and Neck Surgery (K.S.), Nuclear Medicine (A.S), and Imaging (M.C.), and Institute of Pathology (Y.S.), Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel; and Sackler Faculty of Medicine (L.L., Y.L., K.S., M.C., I.Y., M.P.) Tel Aviv University, Tel Aviv 69978, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Phillip
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000145:classification* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D013965:Thyroidectomy; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes