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Prognostic factors in pediatric differentiated thyroid cancer patients with pulmonary metastases

  • Chandra Sekhar Bal EMAIL logo , Aayushi Garg , Saurav Chopra , Sanjana Ballal and Ramya Soundararajan
Published/Copyright: September 11, 2014
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 28 Issue 7-8

Abstract

Aim: This study was aimed at identifying the prognostic factors predicting remission in pediatric differentiated thyroid cancer (DTC) patients presenting with pulmonary metastases. Little is known about the prognostic factors in reference to pediatric DTC patients presenting with pulmonary metastases.

Methods: Fifty-three DTC patients aged ≤21 years were diagnosed with pulmonary metastases at initial presentation. The demographic and disease characteristics were compared between the patients who achieved remission and those who did not.

Results: During the median follow-up of 72 months, 38 patients became disease free, 14 patients had biochemically and/or structurally persistent disease, and one patient died due to disease progression. Patient age >15 years, presence of macronodular pulmonary metastases, and surgical methods lesser than total/near-total thyroidectomy were identified as factors associated with reduced odds of remission.

Conclusion: This study describes the disease course and depicts the disease related prognostic factors in pediatric DTC patients with pulmonary metastases.

Keywords: differentiated thyroid cancer; lung metastases; pediatric; prognosis; remission
Corresponding author: Chandra Sekhar Bal, All India Institute of Medical Sciences, Department of Nuclear Medicine, New Delhi 110029, India, Phone: +91-11-26593530, Fax: +91-11-2658864, E-mail:

References

1. SEER Cancer Statistics Review, 1975–2005. Bethesda: National Cancer Institute, 2008. Available at: http://seer.cancer.gov/csr/1975_2005.Search in Google Scholar

2. Zimmerman D, Hay ID, Gough IR, Goellner JR, Ryan JJ, et al. Papillary thyroid carcinoma in children and adults: long-term follow-up of patients conservatively treated at one institution during three decades. Surgery 1988;104:1157–66.Search in Google Scholar

3. Zueras VM, Blanco AM, Matarranz YR, Perez RP, Morante MC, et al. Differentiated thyroid carcinoma in childhood. An Esp Pediatr 1992;37:11–4.Search in Google Scholar

4. Lamberg BA, Karkinen-Jaaskelainen M, Franssila KO. Differentiated follicle-derived thyroid carcinoma in children. Acta Paediatr Scand 1989;78:419–25.10.1111/j.1651-2227.1989.tb11102.xSearch in Google Scholar PubMed

5. Handkiewicz-Junak D, Wloch J, Roskosz J, Krajewska J, Kropinska A, et al. Total thyroidectomy and adjuvant radioiodine treatment independently decrease locoregional recurrence risk in childhood and adolescent differentiated thyroid cancer. J Nucl Med 2007;48:879–88.10.2967/jnumed.106.035535Search in Google Scholar PubMed

6. Demidchik YE, Demidchik EP, Reiners C, Biko J, Mine M, et al, Comprehensive clinical assessment of 740 cases of surgically treated thyroid cancer in children of Belarus. Ann Surg 2006;243:525–32.10.1097/01.sla.0000205977.74806.0bSearch in Google Scholar PubMed PubMed Central

7. Grigsby PW, Gal-or A, Michalski JM, Doherty GM. Childhood and adolescent thyroid carcinoma. Cancer 2002;95:724–9.10.1002/cncr.10725Search in Google Scholar PubMed

8. Ceccarelli C, Pacini F, Lippi F, Elisei R, Arganini M, et al. Thyroid cancer in children and adolescents. Surgery 1988;104:1143–8.Search in Google Scholar

9. Bal CS, Kumar A, Chandra P, Dwivedi SN, Mukhopadhyaya S. Is chest x-ray or high-resolution computed tomography scan of the chest sufficient investigation to detect pulmonary metastasis in pediatric differentiated thyroid cancer? Thyroid 2004;14:217–25.10.1089/105072504773297894Search in Google Scholar PubMed

10. Brink JS, van Heerden JA, McIver B, Salamao DR, Farley DR, et al. Papillary thyroid cancer with pulmonary metastases in children: long-term prognosis. Surgery 2000;128:881–7.10.1067/msy.2000.109728Search in Google Scholar PubMed

11. La Quaglia MP, Black T, Holcomb GW 3rd, Sklar C, Azizkhan RG, et al. Differentiated thyroid cancer: clinical characteristics, treatment, and outcome inpatients under 21 years of age who present with distant metastases. A report from the Surgical Discipline Committee of the Children’s Cancer Group. J Pediatr Surg 2000;35:955–60.10.1053/jpsu.2000.6935Search in Google Scholar PubMed

12. Samuel AM, Rajashekharrao B, Shah DH. Pulmonary metastases in children and adolescents with well-differentiated thyroid cancer. J Nucl Med 1998;39:1531–6.Search in Google Scholar

13. Showalter TN, Siegel BA, Moley JF, Baranski TJ, Grigsby PW. Prognostic factors in patients with well-differentiated thyroid cancer presenting with pulmonary metastasis. Cancer Biother Radiopharm 2008; 23:655–60.10.1089/cbr.2008.0501Search in Google Scholar PubMed

14. Cho SW, Choi H, Yeom GJ, Lim JA, Moon JH, et al. Long-term prognosis of differentiated thyroid cancer with lung metastasis in Korea and its prognostic factors. Thyroid 2014;24:277–86.10.1089/thy.2012.0654Search in Google Scholar PubMed PubMed Central

15. Ronga G, Filesi M, Montesano T, Di Nicola AD, Pace C, et al. Lung metastases from differentiated thyroid carcinoma. A 40 years’ experience. Q J Nucl Med Mol Imaging 2004;48:12–9.Search in Google Scholar

16. Newman KD, Black T, Heller G, Azizkhan RG, Holcomb GW 3rd, et al. Differentiated thyroid cancer: determinants of disease progression in patients <21 years of age at diagnosis. Ann Surg 2004;227:533–41.10.1097/00000658-199804000-00014Search in Google Scholar PubMed PubMed Central

17. Shapiro NL, Bhattacharyya N. Population-based outcomes for pediatric thyroid carcinoma. Laryngoscope 2005;115:337–40.10.1097/01.mlg.0000154743.71184.09Search in Google Scholar PubMed

18. Wada N, Sugino K, Mimura T, Nagahama M, Kitagawa W, et al. Pediatric differentiated thyroid carcinoma in stage I: risk actor analysis for disease free survival. BMC Cancer 2009;9:306.10.1186/1471-2407-9-306Search in Google Scholar PubMed PubMed Central

19. Pawelczak M, David R, Franklin B, Kessler M, Lam L, et al. Outcomes of children and adolescents with well-differentiated thyroid carcinoma and pulmonary metastases following 131I treatment: a systematic review. Thyroid 2010;20:1095–101.10.1089/thy.2009.0446Search in Google Scholar PubMed

20. Schlumberger M, De Vathaire F, Travagli JP, Vassal G, Lemerle J, et al. Differentiated thyroid carcinoma in childhood: long term follow-up of 72 patients. J Clin Endocrinol Metab 1987;65: 1088–94.10.1210/jcem-65-6-1088Search in Google Scholar PubMed

21. Landau D, Vini L, A’Hern R, Harmer C. Thyroid cancer in children: the Royal Marsden Hospital experience. Eur J Endocrinol 2000;36:214–20.Search in Google Scholar

22. Durante C, Haddy N, Baudin E, Leboulleux S, Hartl D, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab 2006;91:2892–9.10.1210/jc.2005-2838Search in Google Scholar PubMed

23. Verburg FA, Keizer B, Lips CJ, Zelissen PM, de Klerk JM. Prognostic significance of successful ablation with radioiodine of differentiated thyroid cancer patients. Eur J Endocrinol 2005;152:33–7.10.1530/eje.1.01819Search in Google Scholar PubMed

24. Mazzaferri EL, Kloos RT. Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 2001;86:1447–63.10.1210/jcem.86.4.7407Search in Google Scholar PubMed

25. Chow SM, Law SC, Mendenhall WM, Au SK, Yau S, et al. Differentiated thyroid carcinoma in childhood and adolescence-clinical course and role of radioiodine. Pediatr Blood Cancer 2004;42:176–83.10.1002/pbc.10410Search in Google Scholar PubMed

26. Kuo SF, Chao TC, Hsueh C, Chuang WY, Yang CH, et al. Prognosis and risk stratification in young papillary thyroid carcinoma patients. Endocr J 2008;55:269–75.10.1507/endocrj.K07E-127Search in Google Scholar

27. Arici C, Erdogan O, Altunbas H, Boz A, Melikoglu M, et al. Differentiated thyroid carcinoma in children and adolescents: clinical characteristics, treatment and outcome of 15 patients. Horm Res 2002;57:153–6.Search in Google Scholar

28. Giuffrida D, Scollo C, Pellegriti G, Lavenia G, Iurato MP, et al. Differentiated thyroid cancer in children and adolescents. J Endocrinol Invest 2002;25:18–24.10.1007/BF03343956Search in Google Scholar PubMed

29. Haveman JW, Van Tol KM, Rouwe CW, Piers DA, Plukker JT. Surgical experience in children with differentiated thyroid carcinoma. Ann Surg Oncol 2003;10:15–20.10.1245/ASO.2003.03.002Search in Google Scholar

30. Spinelli C, Bertocchini A, Antonelli A, Miccoli P. Surgical therapy of the thyroid papillary carcinoma in children: experience with 56 patients < or = 16 years old. J Pediatr Surg 2004;39:1500–5.10.1016/j.jpedsurg.2004.06.016Search in Google Scholar

31. Massimino M, Gasparini M, Ballerini E, Del Bo R. Primary thyroid carcinoma in children: a retrospective study of 20 patients. Med Pediatr Oncol 1995;24:13–7.10.1002/mpo.2950240104Search in Google Scholar

32. La Quaglia MP, Corbally MT, Heller G, Exelby PR, Brennan MF. Recurrence and morbidity in differentiated thyroid carcinoma in children. Surgery 1988;104:1149–56.Search in Google Scholar

33. Beierwaltes WH. The treatment of thyroid carcinoma with radioactive iodine. Semin Nucl Med 1978;8:79–94.10.1016/S0001-2998(78)80009-9Search in Google Scholar

34. Yeh SD, La Quaglia MP. 131I therapy for pediatric thyroid cancer. Semin Pediatr Surg 1997;6:128–33.Search in Google Scholar

35. Piekarski JD, Schiumberger M, Leclere J, Couanet D, Masselot J, et al. Chest computed tomography (CT) in patients with micronodular lung metastases of differentiated thyroid carcinoma. Int J Radiat Oncol Biol Phys 1985;11:1023–7.10.1016/0360-3016(85)90126-9Search in Google Scholar

36. Tubiana M, Lacour J, Monmer JP, Bergiron C, Gerard-Marchant R, et al. External radiotherapy and radioiodine in the treatment of 359 thyroid cancers. Br J Radiol 1975;48:894–907.10.1259/0007-1285-48-575-894Search in Google Scholar

37. Ozaki O, Ito K, Manabe Y, Nishikawa Y, Mimura T. Clinical studies on pulmonary metastases from differentiated thyroid carcinoma – characteristics of patients with pulmonary metastases which appear before thyroid operation or afterward. Nihon Geka Gakkai Zasshi 1986;87:79–83.Search in Google Scholar

38. Vaisman F, Bulzico DA, Pessoa CH, Bordallo MA, Mendonça UB, et al. Prognostic factors of a good response to initial therapy in children and adolescents with differentiated thyroid cancer. Clinics (Sao Paulo) 2011;66:281–6.10.1590/S1807-59322011000200017Search in Google Scholar

39. Ito Y, Kihara M, Takamura Y, Kobayashi K, Miya A, et al. Prognosis and prognostic factors of papillary thyroid carcinoma in patients under 20 years. Endocr J 2012;59:539–45.10.1507/endocrj.EJ12-0086Search in Google Scholar

40. Bongarzone I, Vigneri P, Mariani L, Collini P, Pilotti S, et al. RET/NTRK1 rearrangements in thyroid gland tumors of the papillary carcinoma family: correlation with clinicopathological features. Clin Cancer Res 1998;4:223–8.Search in Google Scholar

41. Nikiforov YE, Rowland JM, Bove KE, Monforte-Munoz H, Fagin JA. Distinct pattern of ret oncogene rearrangements in morphological variants of radiation-induced and sporadic thyroid papillary carcinomas in children. Cancer Res 1997;57:1690–4.Search in Google Scholar

42. Fenton CL, Lukes Y, Nicholson D, Dinauer CA, Francis GL, et al. The ret/PTC mutations are common in sporadic papillary thyroid carcinoma of children and young adults. J Clin Endocrinol Metab 1997;85:1170–5.Search in Google Scholar

43. Soares P, Fonseca E, Wynford-Thomas D, Sobrinho-Simoes M. Sporadic RET-rearranged papillary carcinoma of the thyroid: a subset of slow growing, less aggressive thyroid neoplasms? J Pathol 1998;185:71–8.10.1002/(SICI)1096-9896(199805)185:1<71::AID-PATH42>3.0.CO;2-SSearch in Google Scholar

44. Kumagai A, Namba H, Mitsutake N, Saenko VA, Ohtsuru A, et al. Childhood thyroid carcinoma with BRAFT1799A mutation shows unique pathological features of poor differentiation. Oncol Rep 2006;16:123–6.10.3892/or.16.1.123Search in Google Scholar

45. Faggiano A, Coulot J, Bellon N, Talbot M, Caillou B, et al. Age-dependent variation of follicular size and expression of iodine transporters in human thyroid tissue. J Nucl Med 2004;45:232–7.Search in Google Scholar

Received: 2014-6-10
Accepted: 2014-8-14
Published Online: 2014-9-11
Published in Print: 2015-7-1

©2015 by De Gruyter

Articles in the same Issue

  1. Frontmatter
  2. Highlight: Thyroid
  3. Thyroid disorders revisited
  4. Genetic analysis of the paired box transcription factor (PAX8) gene in a cohort of Polish patients with primary congenital hypothyroidism and dysgenetic thyroid glands
  5. Prognostic factors in pediatric differentiated thyroid cancer patients with pulmonary metastases
  6. Reclassification of cytologically atypical thyroid nodules based on radiologic features in pediatric patients
  7. Evaluation of inflammatory and oxidative biomarkers in children with well-controlled congenital hypothyroidism
  8. Investigation of autoimmune diseases accompanying Hashimoto’s thyroiditis in children and adolescents and evaluation of cardiac signs
  9. Neonatal thyroid storm accompanied with severe anaemia
  10. Functional characterization of the novel sequence variant p.S304R in the hinge region of TSHR in a congenital hypothyroidism patients and analogy with other formerly known mutations of this gene portion
  11. Subclinical hypothyroidism as a rare cofactor in chronic kidney disease (CKD) – related anemia
  12. Cytometric analysis of perforin expression in NK cells, CD8+, and CD4+ lymphocytes in children with autoimmune Hashimoto’s thyroiditis – a preliminary study
  13. Papillary thyroid cancer and autoimmune polyglandular syndrome
  14. Review article
  15. Should radioiodine be the first-line treatment for paediatric Graves’ disease?
  16. Image in pediatric endrocrinology
  17. Diffusion-weighted magnetic resonance imaging in a case of severe classic maple syrup urine disease
  18. Original articles
  19. Novel mutations of DAX1 (NR0B1) in two Chinese families with X-linked adrenal hypoplasia congenita and hypogonadotropic hypogonadism
  20. Rickets and vitamin D deficiency in Alaska native children
  21. Persistent elevation of fibroblast growth factor 23 concentrations in healthy appropriate-for-gestational-age preterm infants
  22. Parents’ experiences of having a baby with ambiguous genitalia
  23. Effect of GnRHa 3.75 mg subcutaneously every 6 weeks on adult height in girls with idiopathic central precocious puberty
  24. Congenital adrenal hyperplasia in children – a survey on the current practice in the UK
  25. Randomized clinical trial evaluating metformin versus oral contraceptive pills in the treatment of adolescents with polycystic ovarian syndrome
  26. Influence of the body weight on the onset and progression of puberty in boys
  27. Therapy monitoring in congenital adrenal hyperplasia by dried blood samples
  28. Hyperinsulinemic hypoglycemia: think of hyperinsulinism/hyperammonemia (HI/HA) syndrome caused by mutations in the GLUD1 gene
  29. Sulfonylurea in the treatment of neonatal diabetes mellitus children with heterogeneous genetic backgrounds
  30. Monitoring gonadotropin-releasing hormone analogue (GnRHa) treatment in girls with central precocious puberty: a comparison of four methods
  31. Dietary intake, body composition, and physical activity among young patients with type 1 diabetes mellitus
  32. Metabolic syndrome in obese children and adolescents in Serbia: prevalence and risk factors
  33. Progressive osseous heteroplasia, as an isolated entity or overlapping with Albright hereditary osteodystrophy
  34. Patient reports
  35. 17α-Hydroylase/17,20-lyase deficiency related to P.Y27*(c.81C>A) mutation in CYP17A1 gene
  36. A patient developing anaphylaxis and sensitivity to two different GnRH analogues and a review of literature
  37. Idiopathic short stature due to novel heterozygous mutation of the aggrecan gene
  38. Triple A syndrome with a novel indel mutation in the AAAS gene and delayed puberty
  39. Case report: long-term follow-up of a 45,X male with SHOX haploinsufficiency
  40. Antenatal Bartter syndrome presenting as hyperparathyroidism with hypercalcemia and hypercalciuria: a case report and review
  41. Successful use of continuous subcutaneous hydrocortisone infusion after bilateral adrenalectomy secondary to bilateral pheochromocytoma
  42. Donohue syndrome: a new case with a new complication
  43. Euprolactinemic galactorrhea secondary to domperidone treatment
  44. 17βHSD-3 enzyme deficiency due to novel mutations in the HSD17B3 gene diagnosed in a neonate
  45. Two different patterns of mini-puberty in two 46,XY newborns with 17β-hydroxysteroid dehydrogenase type 3 deficiency
  46. Short communication
  47. Early onset hearing loss in autosomal recessive hypophosphatemic rickets caused by loss of function mutation in ENPP1
https://doi.org/10.1515/jpem-2014-0247
Keywords for this article
differentiated thyroid cancer; lung metastases; pediatric; prognosis; remission

Articles in the same Issue

  1. Frontmatter
  2. Highlight: Thyroid
  3. Thyroid disorders revisited
  4. Genetic analysis of the paired box transcription factor (PAX8) gene in a cohort of Polish patients with primary congenital hypothyroidism and dysgenetic thyroid glands
  5. Prognostic factors in pediatric differentiated thyroid cancer patients with pulmonary metastases
  6. Reclassification of cytologically atypical thyroid nodules based on radiologic features in pediatric patients
  7. Evaluation of inflammatory and oxidative biomarkers in children with well-controlled congenital hypothyroidism
  8. Investigation of autoimmune diseases accompanying Hashimoto’s thyroiditis in children and adolescents and evaluation of cardiac signs
  9. Neonatal thyroid storm accompanied with severe anaemia
  10. Functional characterization of the novel sequence variant p.S304R in the hinge region of TSHR in a congenital hypothyroidism patients and analogy with other formerly known mutations of this gene portion
  11. Subclinical hypothyroidism as a rare cofactor in chronic kidney disease (CKD) – related anemia
  12. Cytometric analysis of perforin expression in NK cells, CD8+, and CD4+ lymphocytes in children with autoimmune Hashimoto’s thyroiditis – a preliminary study
  13. Papillary thyroid cancer and autoimmune polyglandular syndrome
  14. Review article
  15. Should radioiodine be the first-line treatment for paediatric Graves’ disease?
  16. Image in pediatric endrocrinology
  17. Diffusion-weighted magnetic resonance imaging in a case of severe classic maple syrup urine disease
  18. Original articles
  19. Novel mutations of DAX1 (NR0B1) in two Chinese families with X-linked adrenal hypoplasia congenita and hypogonadotropic hypogonadism
  20. Rickets and vitamin D deficiency in Alaska native children
  21. Persistent elevation of fibroblast growth factor 23 concentrations in healthy appropriate-for-gestational-age preterm infants
  22. Parents’ experiences of having a baby with ambiguous genitalia
  23. Effect of GnRHa 3.75 mg subcutaneously every 6 weeks on adult height in girls with idiopathic central precocious puberty
  24. Congenital adrenal hyperplasia in children – a survey on the current practice in the UK
  25. Randomized clinical trial evaluating metformin versus oral contraceptive pills in the treatment of adolescents with polycystic ovarian syndrome
  26. Influence of the body weight on the onset and progression of puberty in boys
  27. Therapy monitoring in congenital adrenal hyperplasia by dried blood samples
  28. Hyperinsulinemic hypoglycemia: think of hyperinsulinism/hyperammonemia (HI/HA) syndrome caused by mutations in the GLUD1 gene
  29. Sulfonylurea in the treatment of neonatal diabetes mellitus children with heterogeneous genetic backgrounds
  30. Monitoring gonadotropin-releasing hormone analogue (GnRHa) treatment in girls with central precocious puberty: a comparison of four methods
  31. Dietary intake, body composition, and physical activity among young patients with type 1 diabetes mellitus
  32. Metabolic syndrome in obese children and adolescents in Serbia: prevalence and risk factors
  33. Progressive osseous heteroplasia, as an isolated entity or overlapping with Albright hereditary osteodystrophy
  34. Patient reports
  35. 17α-Hydroylase/17,20-lyase deficiency related to P.Y27*(c.81C>A) mutation in CYP17A1 gene
  36. A patient developing anaphylaxis and sensitivity to two different GnRH analogues and a review of literature
  37. Idiopathic short stature due to novel heterozygous mutation of the aggrecan gene
  38. Triple A syndrome with a novel indel mutation in the AAAS gene and delayed puberty
  39. Case report: long-term follow-up of a 45,X male with SHOX haploinsufficiency
  40. Antenatal Bartter syndrome presenting as hyperparathyroidism with hypercalcemia and hypercalciuria: a case report and review
  41. Successful use of continuous subcutaneous hydrocortisone infusion after bilateral adrenalectomy secondary to bilateral pheochromocytoma
  42. Donohue syndrome: a new case with a new complication
  43. Euprolactinemic galactorrhea secondary to domperidone treatment
  44. 17βHSD-3 enzyme deficiency due to novel mutations in the HSD17B3 gene diagnosed in a neonate
  45. Two different patterns of mini-puberty in two 46,XY newborns with 17β-hydroxysteroid dehydrogenase type 3 deficiency
  46. Short communication
  47. Early onset hearing loss in autosomal recessive hypophosphatemic rickets caused by loss of function mutation in ENPP1
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