PURPOSE This multicentric study aimed to investigate the main prognostic factors associated with treatment response at 1 year after radioactive iodine therapy (RAIT) and the last disease status in pediatric patients affected by differentiated thyroid carcinoma (DTC). MATERIALS AND METHODS In the period 1990-2020, all consecutive patients ≤ 18 years from six different centers were retrospectively included. Patients were classified as low, intermediate, and high risk for persistence/recurrence. The response to RAIT was evaluated and scored 1 year later according to 2015 ATA guidelines. Moreover, at the last follow-up, the disease status was evaluated and dichotomized as no evidence of disease (NED) or persistent disease. RESULTS Two hundred and eighty-five patients (197 female, 88 male; mean age 14.4 years) were recruited. All, except nine, underwent near-total thyroidectomy followed by RAIT. One-year after first RAIT, 146/276 (53%) patients had excellent response, 37/276 (14%) indeterminate response, and 91/276 (33%) incomplete response. One-year after RAIT, children with excellent response had significantly lower stimulated thyroglobulin (sTg) compared to not excellent group (median sTg 4.4 ng/ml vs 52.5 ng/ml, p < 0.001). ROC curve showed sTg higher than 27.2 ng/ml as the most accurate to predict 1-year treatment response. After a median follow-up of 133 months, NED was present in 241 cases (87%) while persistent disease in 35 (13%). At multivariate analysis, sTg and 1-year treatment response categories were both significantly associated with the last disease status (p value 0.023 and < 0.001). CONCLUSIONS In pediatric DTC, sTg is significantly associated with 1-year treatment response and final outcome. However, 1-year response is the principal prognostic factor able to predict pediatric DTCs outcome.

中文翻译：

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甲状腺全切除术和 RAI 治疗的儿童和青少年分化型甲状腺癌的预后因素：一项现实生活中的多中心研究。

目的 这项多中心研究旨在调查与放射性碘治疗 (RAIT) 后 1 年的治疗反应相关的主要预后因素以及受分化甲状腺癌 (DTC) 影响的儿科患者的最后疾病状态。材料与方法 在 1990-2020 年期间，回顾性纳入了来自六个不同中心的所有连续 ≤ 18 岁的患者。患者被分为持续/复发的低、中和高风险。根据 2015 年 ATA 指南，对 RAIT 的反应在 1 年后进行评估和评分。此外，在最后一次随访中，对疾病状态进行了评估，并将其分为无疾病证据 (NED) 或持续性疾病。结果 招募了 285 名患者（197 名女性，88 名男性；平均年龄 14.4 岁）。除了九个之外，所有的，接受了近乎全甲状腺切除术，然后进行了 RAIT。首次 RAIT 一年后，146/276 (53%) 名患者反应良好，37/276 (14%) 患者反应不确定，91/276 (33%) 患者反应不完全。RAIT 后 1 年，反应良好的儿童的刺激甲状腺球蛋白 (sTg) 显着低于不良组（中位 sTg 4.4 ng/ml vs 52.5 ng/ml，p < 0.001）。ROC 曲线显示 sTg 高于 27.2 ng/ml 作为预测 1 年治疗反应的最准确的方法。中位随访 133 个月后，241 例 (87%) 存在 NED，35 例 (13%) 存在持续疾病。在多变量分析中，sTg 和 1 年治疗反应类别均与最后的疾病状态显着相关（p 值 0.023 和 < 0.001）。结论 在儿科 DTC 中，sTg 与 1 年治疗反应和最终结果显着相关。然而，1 年缓解是能够预测儿科 DTC 结果的主要预后因素。