ETA2024 Oral Presentations Oral Session 12: Clinical thyroid cancer research (7 abstracts)
Predictive factors of persistent disease in a large cohort of pediatric patients with differentiated thyroid carcinoma
Simone De Leo 1 , Valeria Bottici 2 , Gabriella Pellegriti 3 , Caterina Mian 4 , Fabio Orlandi 5 , Maria Grazia Castagna 6 , Carlotta Pozza 7 , Malgorzata Wasniewska 8 , Manlio Cabria 9 , Giulia Brigante 10 , Enrico Brignardello 11 , Maria Cristina Vigone 12 , Maria Chiara Zatelli 13 , Alessia Dolci 14 , Emanuela ARVAT 15 , Francesco Giorgino 16 , Marcello Giachetti 17 , Maria Laura Tanda 18 , Laura Fugazzola 19 & Rossella Elisei 20
1Istituto Auxologico Italiano, Irccs, Division of Endocrine and Metabolic Diseases, Milan, Italy; 2University of Pisa, Department of Clinical and Experimental Medicine, Endocrine Unit, Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy, Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Pisa, Italy, Pisa, Italy; 3Endocrinology Unit, Garibaldi Nesima Hospital, Catania, Garibaldi Nesima Hospital, Catania, Italy; 4Operative Unit of Endocrinology, Department of Medicine (Dimed), Endocrinology Unit, University of Padua, Padua, Department of Medicine, Padova, Italy; 5University of Turin, Humanitas-Gradenigo Hospital, Division of Endocrinology and Metabolism, Department of Oncology, Italy; 6University of Siena, Dsmcn, Siena, Italy; 7Sapienza, University of Rome, Experimental Medicine, Roma, Italy; 8University of Messina, Department of Human Pathology of Adulthood and Childhood, Italy; 9E.O. Ospedali Galliera, Department of Nuclear Medicine, Genoa, Italy; 10Unit of Endocrinology, University of Modena and Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy; 11Città Della Salute e Della Scienza Hospital, Transition Unit for Childhood Cancer Survivors, Italy; 12Vita-Salute San Raffaele University, Ircss San Raffaele, Department of Pediatrics, Endocrine Unit, Milan, Italy; 13University of Ferrara, Dept of Medical Sciences, Section of Endocrinology, Ferrara, Italy; 14Graves’ Orbitopathy Centre, Endocrinology Department, Fondazione Irccs Ca’ Granda, University of Milan, Milan, Italy; 15Univ of Torino - Osp Molinette, division of Endocrinology, Torino, Italy; 16Azienda Ospedaliero-Universitaria Policlinico Bari, U.O. Endocrinologia, Professore Ordinario, Bari, Italy; 17San Lorenzo Hospital, Valdagno (Vicenza), Endocrine and Metabolic Service, Complex Operative Unit of Internal Medicine, Italy; 18University of Insubria, Endocrine Unit; Department of Medicine and Surgery, Aou Sette Laghi -Endocrinologia, Via, Varese, Italy; 19Endocrine and Metabolic Department, Istituto Auxologico Italiano Irccs, Departments of Clinical Sciences and Community Health, Division of Endocrine and Metabolic Diseases, Department of Pathophysiology and Transplantation, Istituto Auxologico Italiano Irccs, University of Milan, Milan, Italy, Milan, Italy; 20University of Pisa, Endocrinology Unit, Department of Clinical and Experimental Medicine, Pisa, Italy
Objectives: Differentiated thyroid carcinoma (DTC) in pediatric patients has peculiar clinical, pathological, and molecular characteristics, making its management different from the adult patients. Our study aimed to evaluate the outcome and predictive factors for persistent disease in a large cohort of pediatric patients.
Methods: We performed a multicentric Italian study, enrolling patients aged ≤18 years old, diagnosed with a DTC, since January 2000, and with available outcome information. Persistent disease included both biochemical and structural persistence. Biochemical incomplete response (BIR) was considered if serum thyroglobulin was detectable and/or thyroglobulin antibodies were increasing, with negative imaging, and structural incomplete response (SIR) was considered in case of identified locoregional or distant metastasis.
Results: We enrolled 538 patients; 75% were female, with a median age (interquartile range, IQR) of 15 (13-17) years. Papillary thyroid cancer was diagnosed in 93.5% of patients and more than 50% had lymph node metastases at diagnosis. Vascular invasion and gross extrathyroidal extension were reported in 40% and 17% of patients, respectively. T4 tumors were the 5% of the entire cohort. Radioactive iodine treatment (RAIT) was administered in the large majority of patients (92.5%), with a median activity of 50 mCi (IQR 30-100 mCi). Around one quarter of patients received more than one RAIT cycle, with a total median activity of 88 mCi (30-151.5 mCi). At the whole-body scan (WBS) obtained after the first RAIT, 25% of patients had a lymph nodal uptake and 10% an uptake in at least one distant metastasis. After a median follow-up of 85 months (42-126 months), 414 patients (77%) had an excellent response, 124 patients (23%) had a persistent disease: 68 patients (12.6%) a BIR and 56 patients (10.4%) a SIR. Persistent disease was associated to a higher need of lateral neck compartment lymphadenectomy, papillary histotype (compared to follicular), multifocality, gross extrathyroidal extension, vascular invasion, T4 and N1 according to the 8th edition, the need of RAIT, the finding of lymph node and distant metastases at WBS after RAIT. After multivariate analysis, the variables significantly associated to persistent disease were: gross extrathyroidal extension (OR 2.81, 95% CI 1.49-5.32, P = 0.0015) and the finding of a lymph node uptake at WBS after RAIT (OR 3.31, 95% CI 1.77, 6.19, P = 0.0002).
Conclusions: We report data on the largest Italian series of pediatric DTCs. Tumor outcome is generally favorable, despite the high frequency of advanced stage at diagnosis. Persistent disease is more frequent in case of gross extrathyroidal extension and positive lymph node uptake after the first RAIT.
Volume 101
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