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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

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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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Data availability

The data that support the findings of this study are available from the corresponding author, OK, upon reasonable request.

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Acknowledgements

We would like to thank Dr. Maria-Alexandra Magiakou and Dr. Maria Karantza for referring their patients.

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Authors and Affiliations

  1. Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, 10676, Athens, Greece

    Olga Karapanou, Marinella Tzanela, Barbara Vlassopoulou, Dimitra Vassiliadi & Stylianos Tsagarakis

  2. Department of Nuclear Medicine, Evangelismos Hospital, 10676, Athens, Greece

    Phoebe Rondogianni

  3. Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Faculty of Medicine, National and Kapodistrian University of Athens, Medical School, “Aghia Sofia” Children’s Hospital, 11527, Athens, Greece

    Catherine Dacou-Voutetakis, Dimitrios Chiotis & Christina Kanaka-Gantenbein

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  1. Olga Karapanou
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Correspondence to Olga Karapanou.

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Karapanou, O., Tzanela, M., Rondogianni, P. et al. 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. Endocrine 70, 566–574 (2020). https://doi.org/10.1007/s12020-020-02378-2

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