Risk stratification and long-term monitoring in pediatric thyroid cancer: predictive markers for disease persistence.
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BACKGROUND: Initial risk stratification and dynamic risk stratification are crucial in managing pediatric differentiated thyroid carcinoma (DTC), aiming to guide treatment and long-term follow-up. While adult dynamic stratification is well established, pediatric data remain limited, and no formal recommendations exist for its use. OBJECTIVE: To evaluate the prognostic value of early dynamic risk stratification (EDRS) and postoperative stimulated thyroglobulin (sPOTg) in predicting long-term outcomes in pediatric DTC and to compare EDRS with initial ATA pediatric risk stratification (IRS). METHODS: We conducted a retrospective cohort study of 123 patients ≤18 years with DTC treated at a tertiary center. IRS and EDRS (1-3 years post-treatment) were compared to late dynamic response (LDRS, ≥10 years post-treatment). A total of 83 patients had complete long-term follow-up data. Associations were assessed using chi-square tests, logistic regression, Cohen's kappa, and Cramér's V. ROC curve analysis evaluated the predictive value of sPOTg. RESULTS: Among 83 patients with ≥10 years of follow-up, EDRS showed a strong association with LDRS (Cramér's V = 0.829; P < 0.001), outperforming IRS (Cramér's V = 0.33; P = 0.0029). Concordance between EDRS and LDRS was substantial (kappa = 0.79). Stimulated postoperative thyroglobulin (sPOTg) showed good discriminatory performance for disease persistence, with AUCs of 0.84 (95% CI: 0.70-0.95) at 1-3 years and 0.81 at ≥10 years. CONCLUSION: Early dynamic response is a strong predictor of long-term outcomes and may surpass IRS in prognostic accuracy. sPOTg is a valuable biomarker for both early and late risk assessment. Prospective multicenter validation is warranted.