Shifting paradigms in the management of pediatric
                    differentiated thyroid cancer from static to dynamic risk stratification: a step
                    forward toward precision medicine

Sadegh Ebrahim Ajdari; Babak Shafiei; Motahareh Motazedian; Mohsen Qutbi; Paridokht Esmaeilzadeh; Isa Neshandar Asli; Hamid Javadi; Majid Assadi

doi:10.1055/a-0895-4997

Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 2019; 58(03): 249-257
DOI: 10.1055/a-0895-4997

Original Article

Shifting paradigms in the management of pediatric differentiated thyroid cancer from static to dynamic risk stratification: a step forward toward precision medicine

Dynamic risk stratification and pediatric thyroid cancerParadigmenwechsel bei der Behandlung pädiatrischer differenzierter Schilddrüsenkrebserkrankungen von statischer zu dynamischer Risikostratifizierung: ein Schritt in Richtung PräzisionsmedizinDynamische Risikostratifizierung und Schilddrüsenkrebs bei Kindern

Sadegh Ebrahim Ajdari

¹Department of Nuclear Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

,

Babak Shafiei

¹Department of Nuclear Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

,

Motahareh Motazedian

²Department of Nuclear Medicine, Shiraz Central Hospital, Shiraz, Iran

,

Mohsen Qutbi

¹Department of Nuclear Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

,

Paridokht Esmaeilzadeh

³Department of Otorhinolaryngology, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran

,

Isa Neshandar Asli

¹Department of Nuclear Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

,

Hamid Javadi

⁴Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences (GUOMS), Gorgan, Iran

,

Majid Assadi

⁵The Persian Gulf Nuclear Medicine Research Center, Bushehr University Of Medical Sciences, Bushehr, Iran

› Institutsangaben

Abstract

Introduction This study aimed to assess the usefulness of a risk-adopted management system known as dynamic risk stratification (DRS) in comparison with the American (ATA) and European Thyroid Associations’ (ETA) risk classifications in the management of pediatric patients with differentiated thyroid cancer (DTC).

Materials and Methods The current study included 50 pediatric patients with DTC who were treated with total or near total thyroidectomy and radioiodine ablation whose risk assessment was initially defined according to the ATA and ETA guidelines. During the two years after initial treatment, patients were reclassified according to their DRS.

Results The study showed that the ability of the DRS system to predict the final outcome was superior to that of the ATA and ETA guidelines. The observed variance in predicting final outcome was 2.3 % for ETA, 14.8 % for ATA, and 83.4 % for DRS. In intermediate/high-risk patients, according to the ATA/ETA guidelines, an excellent response to initial therapy resulted in a noteworthy reduction (about 40 %) for detection of structural disease at the time of final follow-up. The risk of structural disease at the time of final follow-up was significantly higher in the structural incomplete response group (HR = 23.34, P = 0.00) and biochemical incomplete response group (HR = 13.83, P = 0.03) than in the excellent response group.

Conclusion The data documented the significance of re-stratifying pediatric patients with DTC on the basis of the findings obtained at the time of or after their initial therapy (total thyroidectomy and radioiodine ablation), predominantly in the intermediate/high-risk patients. In addition, DRS helped to better modulate the later follow-up, excluding a large number of intermediate/high risk patients from needless intensive workups, allowing personalization of follow-up management.

Zusammenfassung

Einleitung Diese Studie sollte die Nützlichkeit eines Risikomanagementsystems, das als dynamische Risikostratifizierung (DRS) bezeichnet wird, im Vergleich zu den Risikoklassifizierungen der American (ATA) und der European Thyroid Associations (ETA) in den Management von pädiatrischen Patienten mit differenziertem Schilddrüsenkrebs (DTC).

Material und Methoden Die aktuelle Studie umfasste 50 pädiatrische Patienten mit DTC, die mit totaler oder nahezu vollständiger Thyreoidektomie und Radiojodablation behandelt wurden, deren Risikobewertung ursprünglich gemäß den ATA- und ETA-Richtlinien definiert wurde.

In den zwei Jahren nach der Erstbehandlung wurden die Patienten neu klassifiziert nach ihren DRS.

Ergebnisse Die Studie zeigte, dass die Fähigkeit des DRS-Systems, das Endergebnis vorherzusagen, den ATA- und ETA-Richtlinien überlegen war. Die beobachtete Abweichung bei der Vorhersage des Endergebnisses betrug 2,3 % für ETA, 14,8 % für ATA und 83,4 % für DRS. Bei Patienten mit mittlerem Risiko/hohemRisiko führte die hervorragende Reaktion auf die initiale Therapie gemäß den ATA/ETA-Richtlinien zu einer bemerkenswerten Verringerung (etwa 40 %) für den strukturellen Nachweis Krankheit zum Zeitpunkt des letzten Follow-up. Das Risiko einer strukturellen Erkrankung zum Zeitpunkt der endgültigen Nachbeobachtung war in der Gruppe mit unvollständiger Strukturgruppe (HR = 23,34, P = 0,00) und der Gruppe mit biochemischen unvollständigen Antworten (HR = 13,83, P = 0,03) als in der ausgezeichneten Antwortgruppe.

Schlussfolgerung Die Daten dokumentieren die Bedeutung der Re-Stratefizierung pädiatrischer Patienten mit DTC auf der Grundlage der Befunde, welche zum Zeitpunkt oder nach der Primärtherapie (totale Thyreoidektomie und Radioiodablation) erhoben wurden, insbesondere bei Patienten mit mittlerem/hohem Risiko. Darüber hinaus trug die DRS dazu bei, die spätere Nachsorge besser anzupassen, wobei einer großen Anzahl von Patienten mit mittlerem/hohem Risiko unnötige Maßnahmen erspart werden konnte durch die Personalisierung des Follow-up-Managements.

Key words

Pediatric differentiated thyroid cancer - dynamic risk stratification (DRS) - American Thyroid Association (ATA) guideline - European Thyroid Association (ETA) guideline

Schlüsselwörter

Differenzierter Schilddrüsenkrebs bei Kindern - dynamische Risikostratifizierung (DRS) - Richtlinie der American Thyroid Association (ATA) - Richtlinie der European Thyroid Association (ETA)

Volltext

Referenzen

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