儿童与青少年分化型甲状腺癌（caDTC）的临床特征和预后与成人有所不同。术后建议对一些中度和高危caDTC患者进行放射碘治疗（RIT）。本研究的目的是评估初次RIT对儿童caDTC患者长期预后的影响，并探讨相关影响因素。根据初次RIT的治疗反应，将所有受试对象分为无临床证据的疾病（NED）组、生化持续性疾病（BPD）组和结构/功能持续性疾病（S/FPD）组。然后，根据ATA指南评估所有三组的疾病状态，并在最后一次随访时进行评估。同时，也评估NED组的无病生存率（DFS）和BPD组及S/FPD组的无进展生存率（PFS）。 在初次RIT后，将117个受试对象分为NED组（n = 29）、BPD组（n = 48）和S/FPD组（n = 34）。在最后一次随访时，NED组的优良反应（ER）、不定性反应（IDR）、生化不完全反应（BIR）和结构不完全反应（SIR）的比例分别为93.10%、6.90%、0%和0%；BPD组的这些比例分别为29.17%、25.00%、43.75%和2.08%；S/FPD组的这些比例分别为11.77%、2.94%、0%和85.29%。NED组的5年DFS率为95.5%。BPD组和S/FPD组的5年PFS率分别为79.2%和48.6%。对于有结构或功能性损害的儿童，男性儿童131I热点病变和术后刺激性血清甲状腺球蛋白（sti-Tg） < 149.80 ng/ml与较长的PFS相关。 对初次RIT的反应可帮助确定caDTC患者后续治疗和随访策略。术后sti-Tg和病变的131I亲和力与PFS相关。版权所有©2023年Wang, Lu, Li, Liu, Wang, Lu, Li, Luo, Zhang, Sun, Wang和Wang。

The clinical features and prognosis of children and adolescents with differentiated thyroid carcinoma (caDTC) are different from that of adults. Postoperative radioiodine therapy (RIT) was recommended for some intermediate and high risk caDTC patients. The objective of this study was to evaluate the long-term prognosis of pediatric caDTC patients with different responses to initial RIT and to explore the related influencing factors.All subjects were assigned to no clinical evidence of disease (NED) group, biochemical persistent disease (BPD) group, or structural/functional persistent disease (S/FPD) group based on the therapeutic response to initial RIT. Then, disease status was evaluated in all three groups at the last follow-up using ATA guidelines. Meanwhile, disease-free survival (DFS) for NED group and the progression-free survival (PFS) for the BPD and S/FPD groups were also assessed.117 subjects were divided into NED group (n=29), BPD group (n=48) and S/FPD group (n=34) after initial RIT. At the last follow-up, excellent response (ER), indeterminate response (IDR), biochemically incomplete response (BIR) and structurally incomplete response (SIR) rates were 93.10%, 6.90%, 0% and 0% in NED group; 29.17%, 25.00%, 43.75% and 2.08% in BPD group; and 11.77%, 2.94%, 0%, and 85.29% in S/FPD group. The 5-year DFS rate in NED group was 95.5%. The 5-year PFS rates in BPD and S/FPD groups were 79.2% and 48.6%, respectively. For children with structural or functional lesions, longer PFS were found in male children with 131I-avid lesions, and post-operative stimulated serum thyroglobulin (sti-Tg) < 149.80 ng/ml.The response to initial RIT could be helpful for defining subsequent treatment and follow-up strategies for caDTC patients. Post-operative sti-Tg and 131I-avidity of lesions are correlated with PFS.Copyright © 2023 Wang, Lu, Li, Liu, Wang, Lu, Li, Luo, Zhang, Sun, Wang and Wang.