Background/Objectives: To analyze the clinical characteristics of differentiated thyroid cancer (DTC) in children and adolescents. Materials & Methods: Medical records of 31 DTC cases that were diagnosed and treated at Korea Cancer Center Hospital between 2002 and 2018 were retrospectively reviewed....
Background/Objectives: To analyze the clinical characteristics of differentiated thyroid cancer (DTC) in children and adolescents. Materials & Methods: Medical records of 31 DTC cases that were diagnosed and treated at Korea Cancer Center Hospital between 2002 and 2018 were retrospectively reviewed. Results: Most cases were papillary carcinoma (n=26), with female predominance (n=25). Median age was 16.4 years (range, 11.9-18.6 years). Extrathyroidal extension was present in 24 cases. Twenty cases had tumor involvement at cervical lymph nodes and three had lung metastasis. Twenty-two patients received radioactive iodide treatment with a median cumulative dose of 300 mCi (range, 100-920 mCi). During a median follow-up of 68.2 months (range, 2.3-191.4 months), serum thyroglobulin level was elevated in 15 patients. Among them, two cases had remnant thyroid tissue, 4 had recurrence at cervical lymph nodes, and the remaining 9 did not have any detectable lesion. All were alive, and 5-year event-free survival (EFS) was 45.2±10.1%. Age £15 years, tumor size, lymph node status (N1b), and distant metastasis had negative effects on EFS. On multivariate analysis, age and tumor size had prognostic significance. Conclusion: For DTC of children and adolescents (£18 years old), age ≤15 years and tumor size were prognostic factor. Therefore, patients in this age group need meticulous follow-up. Further studies are necessary to answer the potential influence of age on the incidence and behavior of DTC.
Background/Objectives: To analyze the clinical characteristics of differentiated thyroid cancer (DTC) in children and adolescents. Materials & Methods: Medical records of 31 DTC cases that were diagnosed and treated at Korea Cancer Center Hospital between 2002 and 2018 were retrospectively reviewed. Results: Most cases were papillary carcinoma (n=26), with female predominance (n=25). Median age was 16.4 years (range, 11.9-18.6 years). Extrathyroidal extension was present in 24 cases. Twenty cases had tumor involvement at cervical lymph nodes and three had lung metastasis. Twenty-two patients received radioactive iodide treatment with a median cumulative dose of 300 mCi (range, 100-920 mCi). During a median follow-up of 68.2 months (range, 2.3-191.4 months), serum thyroglobulin level was elevated in 15 patients. Among them, two cases had remnant thyroid tissue, 4 had recurrence at cervical lymph nodes, and the remaining 9 did not have any detectable lesion. All were alive, and 5-year event-free survival (EFS) was 45.2±10.1%. Age £15 years, tumor size, lymph node status (N1b), and distant metastasis had negative effects on EFS. On multivariate analysis, age and tumor size had prognostic significance. Conclusion: For DTC of children and adolescents (£18 years old), age ≤15 years and tumor size were prognostic factor. Therefore, patients in this age group need meticulous follow-up. Further studies are necessary to answer the potential influence of age on the incidence and behavior of DTC.
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제안 방법
Cervical ultrasonography, chest CT, and diagnostic 123I whole body scan were performed within 1 year after RAI therapy. Cervical ultrasonography was performed annually for 5 years, then once every 2 years. Regular follow-up evaluations were performed every 6 months with clinical assessment and with laboratory tests including complete blood counts (CBC), chemistry, serum TSH, thyroglobulin and anti-thyroglobulin antibody levels.
RAI therapy was repeated when their serum thyroglobulin was elevated, or until no clinical evidence of remnant thyroid tissue and functioning metastasis based on post-treatment RAI scan. Cervical ultrasonography, chest CT, and diagnostic 123I whole body scan were performed within 1 year after RAI therapy. Cervical ultrasonography was performed annually for 5 years, then once every 2 years.
Our study has several limitations. First, this was a retrospective study involving a small number of patients, and treatments did not exactly follow the ATA guidelines, especially for those with follicular carcinoma or synchronous primary tumors. For follicular carcinoma, controversy exists about the long-term outcomes and risk-stratification of children who would benefit from more extensive thyroid surgery and RAI.
In this retrospective study, we analyzed the clinical characteristics of pediatric/adolescent DTC cases that were diagnosed and treated at our hospital. Especially, we aimed to find clinical variables that are related with structural or biochemical recurrences of DTC.
Cervical ultrasonography was performed annually for 5 years, then once every 2 years. Regular follow-up evaluations were performed every 6 months with clinical assessment and with laboratory tests including complete blood counts (CBC), chemistry, serum TSH, thyroglobulin and anti-thyroglobulin antibody levels.
To identify factors that could predict treatment outcome of pediatric/adolescent DTC, Kaplan-Meier survival analysis was used to examine relations between clinicopathologic variables and EFS. The variables assessed included age, sex, pathologic diagnosis, tumor size, multifocality, extrathyroidal extension (ETE), lymph node involvement, and distant metastasis at the time of diagnosis. Events were defined as either elevated serum thyroglobulin level or clinically detectable diseases during the follow-up period.
대상 데이터
6 years). The pathologic diagnosis was papillary carcinoma in 26 patients (including 2 follicular variant and 3 microcarcinoma), and follicular carcinoma in 5 cases. There were 25 female and 6 male patients.
The pathologic diagnosis was papillary carcinoma in 26 patients (including 2 follicular variant and 3 microcarcinoma), and follicular carcinoma in 5 cases. There were 25 female and 6 male patients. Three cases had previous cancer history and one patient had synchronous primary tumors, including papillary thyroid carcinoma.
22 was diagnosed as neuroblastoma when she was 4 months old, and received intensive treatment comprising surgery, high-dose chemotherapy and MIBG therapy. When she was 14.5 years old, the patient was diagnosed with osteosarcoma of left humerus. More, thyroid cancer was incidentally detected on chest CT, which was performed for metastatic surveillance.
데이터처리
Factors found to influence the EFS on univariate analysis were analyzed by multivariate analysis using Cox's proportional hazard regression model, results of which are reported with relative risks and 95% confidence intervals.
Events were defined as either elevated serum thyroglobulin level or clinically detectable diseases during the follow-up period. The log-rank test was used to calculate survival differences according to clinicopathologic variables. Factors found to influence the EFS on univariate analysis were analyzed by multivariate analysis using Cox's proportional hazard regression model, results of which are reported with relative risks and 95% confidence intervals.
이론/모형
To identify factors that could predict treatment outcome of pediatric/adolescent DTC, Kaplan-Meier survival analysis was used to examine relations between clinicopathologic variables and EFS. The variables assessed included age, sex, pathologic diagnosis, tumor size, multifocality, extrathyroidal extension (ETE), lymph node involvement, and distant metastasis at the time of diagnosis.
성능/효과
This retrospective study analyzed the clinicopathologic characteristics of DTC in children and adolescents, and found that age and tumor size were an important prognostic factor. DTC in patients £15 years had a more aggressive feature than adolescents, with more ETE and recurrence.
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