Puberty and sex in pediatric thyroid cancer: could expression of estrogen and progesterone receptors affect prognosis?

Julia Ramalho Amalio Da Silva Breder,Fernanda Vaisman,Fernanda Andrade Accioly,Daniel Alves Bulzico,Priscila Valverde,Mario Vaisman,Paulo Alonso Garcia Alves,Rossana Corbo,Barbara Pires,Mario Lucio Araújo

doi:10.1530/etj-21-0090

Julia Ramalho Amalio Da Silva Breder, Fernanda Vaisman + Show 8 more

Open Access

https://doi.org/10.1530/etj-21-0090

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Abstract

ObjectiveA sharp increase in pediatric thyroid cancer incidence is observed during adolescence, driven mainly by girls. Differences in disease presentation across sexual maturity stages raise the question of whether sex steroids have a role in the heterogeneity. The aims of this study were to analyze the influence of puberty and sex on clinical presentation and prognosis and to evaluate the correlation between the expression of sex hormone receptors.Design and methodsClinical records and immunohistochemical of specimens from 79 patients were analyzed. Puberty was analyzed by two criteria: end of puberty and beginning, in which the age of 10 was the cutoff.ResultsPostpubertal were more frequently classified as having low-risk disease and a lower frequency of persistent disease, especially when the completion of puberty was used as the criteria. Male sex was associated with a higher risk of persistent disease at the end of the observation period. Estrogen receptor α positivity was low in the entire sample, while progesterone receptor positivity was positive in 30% of the cases. Female hormone receptor expression was not associated with sex, American Thyroid Association risk score, persistent structural disease, or pubertal status.ConclusionOur study showed that the completion of puberty correlated best with the clinical behaviour of pediatric thyroid cancer. It was also shown that postpubertal patients have a less aggressive initial presentation and better outcomes. However, this observation could not be explained by the expression of estrogen and progesterone receptors in the primary tumors.

Highlights

Differentiated thyroid carcinoma (DTC) is the most common endocrine tumor during childhood [1, 2]
Cordioli et al observed a higher expression of sodium iodine symporter (NIS), pendrin, and TSH receptor by thyroid tumor cells in adolescents compared with patients younger than 10 years [7]
Sisdelli et al demonstrated an association between AGK-BRAF fusion and distant metastasis and younger age [4]

Summary

Introduction

Differentiated thyroid carcinoma (DTC) is the most common endocrine tumor during childhood [1, 2]. Recent studies have reported an increasing incidence of DTC in children and adolescents [1, 3]. Girls are responsible for the sharp increased incidence observed during adolescence, with the girl-to-boy ratio varying from 2:1 to 5:1 in this period [3]. Previous studies have suggested some clinical differences between prepubertal and pubertal pediatric DTC. Prepubertal patients present with a greater prevalence of lymph node [6, 7] and lung metastasis [8] at diagnosis than pubertal patients. Cordioli et al observed a higher expression of sodium iodine symporter (NIS), pendrin, and TSH receptor by thyroid tumor cells in adolescents compared with patients younger than 10 years [7]. Sisdelli et al demonstrated an association between AGK-BRAF fusion and distant metastasis and younger age [4]

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Conclusion