Prognostic analysis of persistent disease in medium-to high-risk children and adolescents with differentiated thyroid carcinoma

Huanxin Liang; Jinsi Chen; Zhixiao Wei; Junhong Li

doi:10.1515/jpem-2025-0218

Article

Prognostic analysis of persistent disease in medium-to high-risk children and adolescents with differentiated thyroid carcinoma

Huanxin Liang , Jinsi Chen , Zhixiao Wei and Junhong Li

Published/Copyright: November 18, 2025

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 38 Issue 12

Abstract

Objectives

This multicentre retrospective study aimed to characterise progression-free survival (PFS) patterns and identify clinicopathological factors associated with disease progression in childhood and adolescent differentiated thyroid carcinoma (caDTC) patients with intermediate-to high-risk persistent disease.

Methods

All patients underwent initial treatment comprising total or near-total thyroidectomy, followed by radioiodine therapy and thyroid-stimulating hormone suppression. Univariate analysis using the log-rank test was performed to evaluate prognostic factors associated with PFS in caDTC patients. The median follow-up duration was 56.1 months (range: 15–112 months).

Results

The 1-, 3-, and 5-year PFS rates among intermediate- and high-risk caDTC patients with persistent disease were 82 , 55, and 32 %, respectively. The median PFS in the structural/functional persistent disease (S/FPD) group was significantly shorter than that in the biochemical persistent disease group (21.5 vs. 51.0 months, p<0.001). High-risk American Thyroid Association (ATA) recurrence risk stratification, stimulated thyroglobulin (sTg) levels ≥ 32.9 ng/mL, and S/FPD response to initial radioiodine therapy (RIT) were significantly associated with poor PFS. The optimal sTg cut-off value for predicting S/FPD status was 32.9 ng/mL, with an area under the receiver operating characteristic curve of 0.76. Sensitivity and specificity were 68 and 88 %, respectively.

Conclusions

Among caDTC patients with intermediate-to high-risk persistent disease, those with high-risk ATA recurrence stratification, sTg levels ≥ 32.9 ng/mL, and S/FPD response to initial RIT might require more aggressive treatment and closer clinical surveillance.

Keywords: children and adolescents; differentiated thyroid cancer; recurrence risk stratification; progression-free survival

Corresponding author: Junhong Li, The First Affiliated Hospital of Guangxi Medical University, Nanning, China, E-mail: ljhong333@163.com

Funding source: Guangxi Medical and Health Appropriate Technology Development and Application Project

Research ethics: Date: 2025-1-16. ID:2025-E0042.
Informed consent: Not applicable.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Use of Large Language Models, AI and Machine Learning Tools: None declared.
Conflict of interest: The authors state no conflict of interest.
Research funding: Guangxi Medical and Health Appropriate Technology Development and Application Project (Project Contract number: s2018077).
Data availability: Not applicable.

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Received: 2025-04-21

Accepted: 2025-10-14

Published Online: 2025-11-18

Published in Print: 2025-12-17

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Articles in the same Issue

https://doi.org/10.1515/jpem-2025-0218

Keywords for this article

children and adolescents; differentiated thyroid cancer; recurrence risk stratification; progression-free survival