Goldstein, Andrei Liviu1; Chiriac, Iulia Andreea1; Ghemigian, Adina1,2; Ghemigian, Mircea Vasile1; Brasoveanu, Daniel1; Procopiuc, Camelia1; Alexiu, Florin1; Purice, Mariana1; Voicu, Gabriela1; Goldstein, Daniela1; Ioachim, Dumitru1; Gherlan, Iuliana1,2
1 ”C.I.Parhon” National Institute of Endocrinology, Bucharest, Romania
2”Carol Davila” University of Medicine and Pharmacy”, Bucharest, Romania
Background: The MACIS scoring system (metastases, age at diagnosis, completeness of resection, invasion, size of the tumor) is used to identify aggressive behaviour in differentiated thyroid carcinoma (DTC) in adults, with a cut-off score of 6.
Aim: to identify the clinical, biochemical and therapeutic factors associated with unfavourable course of DTC and to propose a cut-off value of MACIS score in children.
Methods: The medical records of 54 children and adolescents admitted in a tertiary centre of endocrinology were reviewed retrospectively. ”Aggressive behaviour” of DTC was defined: local invasion, extensive lateral cervical lymph node/distant metastasis, recurrent/persistent disease. Receiver operating characteristic (ROC) analysis was performed to determine the MACIS scoring cut-off for predicting poor prognosis.
Results: Extrathyroidal invasion was noted in 25.9% cases, extensive regional lymph node metastasis in 27.7%, distant metastases in 9.2% cases. Total thyroidectomy was performed in 63% cases, total thyroidectomy and lymph node dissection in 35.2% cases. Postoperative adjuvant RAI treatment was used in 35 patients (77%).
After a follow-up period of 30.4 months, local recurrence and persistent biochemical/structural disease were noted in 5.5% cases and 20.4 % cases respectively. Smaller age at diagnosis, multifocal carcinoma, histological type (the diffuse sclerosing papillary thyroid carcinoma and cribriform papillary carcinoma) and invasive forms of DTC were significant predictor factors for poor prognosis. A MACIS score ?3.8 had 95% sensitivity and 65% specificity for aggressive behaviour.
Discussion&Conclusion: Clinical and pathological factors, as well as MACIS scoring system have good ability in predicting aggressive behaviour of DTC in children.
- Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM, Dinauer CA, Hamilton J, Hay ID, Luster M, Parisi MT, Rachmiel M, Thompson GB, Yamashita S; American Thyroid Association Guidelines Task Force. Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2015 Jul;25(7):716-59. doi: 10.1089/thy.2014.0460. Review.