Clinical characteristics, risk stratifications, and long-term follow-up of childhood differentiated thyroid cancer: a single-center experience

Abstract

Purpose: Guidelines of the Pediatric American Thyroid Association (ATA) serve as a vital reference for managing the rare thyroid cancers in childhood. This study evaluates differentiated thyroid cancer (DTC) patients using the ATA guidelines, dynamic risk stratification (DRS), and other established risk classification systems.

Methods: Pediatric patients with DTC under observation after total thyroidectomy were included in the study. We assessed preoperative and postoperative features based on the ATA guidelines, other risk scoring systems (TNM; De Groot staging; metastasis, age, completeness of resection, invasion, and tumor size; and combined risk), and the DRS.

Results: A total of 41 patients was enrolled in the study, with a median follow-up duration of 5.14±3.94 years. Of the patients who underwent total thyroidectomy, 33 were diagnosed with papillary carcinoma and 8 with follicular thyroid carcinoma. During follow-up, cervical metastases were detected in 27 patients, and one had distant metastasis. All patients underwent total thyroidectomy, and 68% received lymph node dissection. Additionally, 16 patients received radioactive iodine therapy. Of the postoperative patients, 85.3% were classified as low risk. Based on DRS, patients were classified as having no evidence of disease (n=29, 70.7%), biochemical evidence of persistent disease (n=5, 12.2%), structural evidence of persistent disease (n=6, 14.6%), and recurrent disease (n=1, 2.5%). Notably, 98% of the patients showed no evidence of disease during their latest follow-up.

Conclusion: Persistent disease in patients classified as low risk according to the ATA guidelines resolved following radioactive iodine therapy, emphasizing the importance of risk stratification in postoperative care.

Keywords: Dynamic risk stratification; Pediatric differentiated thyroid cancer; Risk classification systems.