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Volume 15
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Article

Differentiated Thyroid Cancer Long-Term Outcomes and Risk Stratification in Pediatric and Adolescent Patients: A 44-Year Retrospective Study

by
Marko Buta
1,2,
Nada Santrac
1,2,
Merima Goran
1,2,
Nikola Jeftic
2,
Jovan Raketic
2,*,
Nevena Savkovic
2,
Saska Pavlovic
2,
Milan Zegarac
1,2,
Neven Jokic
2,
Ana Cvetkovic
1,3,
Marko Stojanovic
1,4,
Ana Jotic
1,5,
Dusica Gavrilovic
6 and
Ivan Markovic
1,2
1
School of Medicine, University of Belgrade, Dr Subotica 8, 11 000 Belgrade, Serbia
2
Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11 000 Belgrade, Serbia
3
Department of Anesthesiology, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11 000 Belgrade, Serbia
4
Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr Subotica 13, 11 000 Belgrade, Serbia
5
Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia, Pasterova 2, 11 000 Belgrade, Serbia
6
Data Center, Institute of Oncology and Radiology of Serbia, Pasterova 14, 11 000 Belgrade, Serbia
*
Author to whom correspondence should be addressed.
Diagnostics 2025, 15(4), 399; https://doi.org/10.3390/diagnostics15040399
Submission received: 29 December 2024 / Revised: 27 January 2025 / Accepted: 5 February 2025 / Published: 7 February 2025
(This article belongs to the Special Issue Prognostic Factors for Pediatric Tumors, 2nd Edition)
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Abstract

Background: Differentiated thyroid cancer (DTC) in children and adolescents is a rare but significant malignancy, often presenting at more advanced stages compared to adults, although it is associated with favorable long-term outcomes. This study aimed to identify prognostic factors and perform risk stratification with the goal of identifying low-risk patients who would benefit from a less radical treatment approach. Methods: This retrospective cohort study included patients aged 21 years and younger with DTC treated at the Institute for Oncology and Radiology of Serbia between 1980 and 2024. Results: The study analyzed 99 patients (39 children, 60 adolescents) with a median follow-up of 15.6 years (range: 0.6–43.6 years). No significant differences in long-term outcomes were observed between children and adolescents. Multivariate regression analysis identified a total number of more than 10.5 positive lymph nodes and extrathyroidal tumor extension as independent predictors of adverse events and event-free interval (EFI). Using these prognostic factors, patients were stratified into three groups: low-risk (no risk factors), intermediate-risk (one of two risk factors), and high-risk (both risk factors). Statistically significant differences in EFI were observed among the three groups. Notably, none of the patients in the low-risk group had evidence of disease after treatment. Patients classified as having no evidence of disease after treatment demonstrated significantly better EFI compared to those with evidence of disease. Conclusions: Our findings highlight the importance of meticulous risk stratification in predicting long-term outcomes and might serve as a basis for developing personalized therapeutic strategies. Identifying low-risk patients who may benefit from a less aggressive treatment approach while ensuring optimal treatment and follow-up for high-risk patients remains a central objective in the modern management of DTC.
Keywords: differentiated thyroid cancer; children; adolescents; prognostic factors; long-term outcomes; risk stratification differentiated thyroid cancer; children; adolescents; prognostic factors; long-term outcomes; risk stratification

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MDPI and ACS Style

Buta, M.; Santrac, N.; Goran, M.; Jeftic, N.; Raketic, J.; Savkovic, N.; Pavlovic, S.; Zegarac, M.; Jokic, N.; Cvetkovic, A.; et al. Differentiated Thyroid Cancer Long-Term Outcomes and Risk Stratification in Pediatric and Adolescent Patients: A 44-Year Retrospective Study. Diagnostics 2025, 15, 399. https://doi.org/10.3390/diagnostics15040399

AMA Style

Buta M, Santrac N, Goran M, Jeftic N, Raketic J, Savkovic N, Pavlovic S, Zegarac M, Jokic N, Cvetkovic A, et al. Differentiated Thyroid Cancer Long-Term Outcomes and Risk Stratification in Pediatric and Adolescent Patients: A 44-Year Retrospective Study. Diagnostics. 2025; 15(4):399. https://doi.org/10.3390/diagnostics15040399

Chicago/Turabian Style

Buta, Marko, Nada Santrac, Merima Goran, Nikola Jeftic, Jovan Raketic, Nevena Savkovic, Saska Pavlovic, Milan Zegarac, Neven Jokic, Ana Cvetkovic, and et al. 2025. "Differentiated Thyroid Cancer Long-Term Outcomes and Risk Stratification in Pediatric and Adolescent Patients: A 44-Year Retrospective Study" Diagnostics 15, no. 4: 399. https://doi.org/10.3390/diagnostics15040399

APA Style

Buta, M., Santrac, N., Goran, M., Jeftic, N., Raketic, J., Savkovic, N., Pavlovic, S., Zegarac, M., Jokic, N., Cvetkovic, A., Stojanovic, M., Jotic, A., Gavrilovic, D., & Markovic, I. (2025). Differentiated Thyroid Cancer Long-Term Outcomes and Risk Stratification in Pediatric and Adolescent Patients: A 44-Year Retrospective Study. Diagnostics, 15(4), 399. https://doi.org/10.3390/diagnostics15040399

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