Dynamic Risk Stratification for Predicting Long-term Outcomes in Pediatric Differentiated Thyroid Cancers


 
 
 The American Thyroid Association (ATA) guidelines recommend Dynamic Risk Stratification (DRS) for predicting long-term outcomes and personalizing management in adult differentiated thyroid cancers (DTCs). However, its applicability in pediatric DTCs needs to be validated. Here, we attempted a validation study concerning the use of DRS in pediatric DTCs.
 
 
 
 Data of children (age ≤18 years) with DTCs and follow-up of ≥5 years were extracted. All patients were classified according to DRS (excellent, biochemical-, or structural-incomplete responses). Univariate and multivariate analyses were done to identify factor(s) affecting disease-free survival (DFS).
 
 
 
 We included 176 pediatric DTC patients (median age at diagnosis: 15 years). All patients underwent thyroidectomy and received radioiodine as part of initial management. On the basis of clinical, biochemical, and imaging findings acquired during the first two years of follow-up, the DRS system divided patients into three response categories: excellent response in 82/176 (46.6%), biochemical-incomplete in 56/176 (31.8%), and structural-incomplete response in 38/176 (21.6%) patients. The median follow-up was 10.6 years (interquartile range: 7.7-15.5). Ten-year overall survival and DFS rates were 100% and 88.7%, respectively. In univariate analysis, DFS was significantly affected by extra-thyroidal extension (p = 0.002), lymph node metastasis (p = 0.018), ATA initial risk stratification (p = 0.033), and DRS (p = 0.004). However, in multivariate analysis, DRS alone showed a significant association with DFS (p = 0.016).
 
 
 
 Like adults, DRS correctly predicts long-term outcomes in pediatric DTC. In addition to ATA initial risk stratification, DRS could further refine risk in pediatric DTCs and help in planning more personalised treatment and follow-up strategies.
