Initial and Dynamic Risk Stratification of Pediatric Patients With Differentiated Thyroid Cancer.
The objective of this study was to evaluate the usefulness of American Thyroid Association (ATA) risk classification and dynamic risk stratification (DRS) based on the response to initial therapy in pediatric patients with differentiated thyroid cancer (DTC).



This historical cohort study included 77 pediatric patients with DTC who underwent thyroid surgery. Clinical outcomes during median 5.3 years of follow up were assessed according to 3 ATA risk groups and 4 DRS groups.



In ATA risk classification, 22%, 48%, and 30% of patients were in the low-, intermediate-, and high-risk groups, respectively. There was no significant difference in disease-free survival (DFS) between the indeterminate and the low-risk group. The risk of recurrent/persistent disease was significantly higher only in the high risk group [hazard ratio (HR), 18.4; P = 0.005]. In DRS, 49%, 13%, 6%, and 31% of patients were classified in the excellent, indeterminate, biochemical incomplete, and structural incomplete response groups, respectively. The risk of recurrent/persistent disease was significantly higher in the indeterminate group (HR, 10.2; P = 0.045) and in the structural incomplete group (HR, 98.7; P = 0.005) compared with the excellent response group.



DRS based on the response to initial therapy could be useful in addition to initial ATA pediatric risk classification to predict recurrent/persistent disease in pediatric patients with DTC.
Department of Surgery.
Tae Yon
TY
Sung
Department of Internal Medicine, and.
Min Ji
MJ
Jeon
Department of Surgery.
Yi Ho
YH
Lee
Department of Surgery.
Yu-Mi
YM
Lee
Department of Internal Medicine, and.
Hyemi
H
Kwon
Department of Surgery.
Jong Ho
JH
Yoon
Department of Surgery.
Ki-Wook
KW
Chung
Department of Internal Medicine, and.
Won Gu
WG
Kim
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
Dong Eun
DE
Song
Department of Surgery.
Suck Joon
SJ
Hong
D018263:Adenocarcinoma, Follicular / Q000473:pathology / Q000628:therapy*; D000293:Adolescent; D002277:Carcinoma / Q000473:pathology / Q000628:therapy*; D002291:Carcinoma, Papillary; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007011:Hypoparathyroidism / Q000453:epidemiology / Q000503:physiopathology; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D009333:Neck; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000473:pathology / Q000628:therapy*; D013965:Thyroidectomy; D016896:Treatment Outcome
D007457:Iodine Radioisotopes