分化型甲状腺癌患儿的初始和动态风险分层

Tae-Yon Sung, M. Jeon, Y. Lee, Y. Lee, Hyemi Kwon, J. Yoon, K. Chung, Won Gu Kim, D. Song, S. Hong
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引用次数: 25

摘要

本研究的目的是评估美国甲状腺协会(ATA)风险分类和动态风险分层(DRS)基于初始治疗对分化型甲状腺癌(DTC)患儿的疗效。方法本研究纳入77例行甲状腺手术的小儿DTC患者。根据3个ATA风险组和4个DRS组评估中位5.3年随访期间的临床结果。结果在ATA风险分类中,低危、中危、高危组分别占22%、48%和30%。不确定组和低危组无病生存期(DFS)无显著差异。只有高危组复发/持续性疾病的风险显著高于高危组[危险比(HR), 18.4;P = 0.005]。在DRS中,49%、13%、6%和31%的患者分别被分为极好、不确定、生化不完全和结构不完全缓解组。不确定组复发/持续性疾病的风险明显更高(HR, 10.2;P = 0.045),结构不完整组(HR, 98.7;P = 0.005)。结论基于初始治疗反应的sdrs可用于预测DTC患儿的复发/持续性疾病。
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Initial and Dynamic Risk Stratification of Pediatric Patients With Differentiated Thyroid Cancer
Background The objective of this study was to evaluate the usefulness of American Thyroid Association (ATA) risk classification and dynamic risk stratification (DRS) based on the response to initial therapy in pediatric patients with differentiated thyroid cancer (DTC). Methods This historical cohort study included 77 pediatric patients with DTC who underwent thyroid surgery. Clinical outcomes during median 5.3 years of follow up were assessed according to 3 ATA risk groups and 4 DRS groups. Results In ATA risk classification, 22%, 48%, and 30% of patients were in the low-, intermediate-, and high-risk groups, respectively. There was no significant difference in disease-free survival (DFS) between the indeterminate and the low-risk group. The risk of recurrent/persistent disease was significantly higher only in the high risk group [hazard ratio (HR), 18.4; P = 0.005]. In DRS, 49%, 13%, 6%, and 31% of patients were classified in the excellent, indeterminate, biochemical incomplete, and structural incomplete response groups, respectively. The risk of recurrent/persistent disease was significantly higher in the indeterminate group (HR, 10.2; P = 0.045) and in the structural incomplete group (HR, 98.7; P = 0.005) compared with the excellent response group. Conclusions DRS based on the response to initial therapy could be useful in addition to initial ATA pediatric risk classification to predict recurrent/persistent disease in pediatric patients with DTC.
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