Prognostic Analysis of Recurrence in Children and Adolescents with Differentiated Thyroid Cancer
Differentiated thyroid carcinoma (DTC) is a relatively rare malignancy in children and adolescents, accounting for only 1.5% of all papillary thyroid carcinomas (PTCs). Despite its rarity, pediatric DTC exhibits distinct clinical behaviors compared to its adult counterpart, including aggressive disease presentation, high recurrence rates, and paradoxically favorable disease-specific survival. The management of pediatric DTC remains challenging due to the lack of robust clinical evidence guiding treatment strategies. This study aims to summarize clinical experiences and identify risk factors for postoperative recurrence in children and adolescents with DTC, with the goal of developing more effective clinical strategies for this patient population.
The study retrospectively analyzed 150 patients aged 18 years or younger who were diagnosed with DTC and treated at the Cancer Hospital of the Chinese Academy of Medical Sciences between January 1999 and December 2014. Patients were excluded if they received initial treatment at another hospital, had incomplete clinical data, a history of head-neck radiation exposure, a family history of thyroid cancer, or poorly differentiated thyroid carcinoma. The demographic, clinical, and pathological data were collected from electronic medical records, surgical records, and pathological reviews. The follow-up duration ranged from 6 months to 15 years, with a mean follow-up of 102.9 months.
The demographic and clinical characteristics of the study population revealed a mean age at diagnosis of 14.7 years, with a female-to-male ratio of 1.94:1. The most common presenting symptom was a cervical mass (82.0%), followed by hoarseness (4.7%) and dyspnea (1.3%). All patients underwent initial thyroid surgery, with 54.7% receiving total thyroidectomy and 45.3% undergoing partial thyroidectomy. Postoperative radioiodine (131I) therapy was administered to 56.0% of patients, with a median cumulative dose of 200 mCi. Distant metastasis at diagnosis was observed in 12.0% of patients, all of whom had lung metastases.
Pathological analysis showed that 98.0% of patients had papillary thyroid carcinoma, with a median tumor size of 24.2 mm. Extrathyroidal extension was present in 57.3% of cases, and lymph node metastasis was observed in 87.3% of patients. The surrounding tissues invaded by the tumor included muscle tissue (10.0%), the recurrent laryngeal nerve (16.0%), neck vessels (5.3%), and the trachea or esophageal wall (12.0%).
During the follow-up period, only one disease-related death occurred, attributed to sudden asphyxia following reoperation for central neck recurrence. Recurrence was observed in 21.3% of patients, with recurrence rates of 13.6%, 18.7%, and 28.6% at 3, 5, and 10 years, respectively. Univariate analysis identified age, extrathyroidal extension, lymph node metastasis, and invasion of the trachea or esophageal wall as significant risk factors for recurrence. Multivariate Cox regression analysis confirmed that younger age and extrathyroidal extension were independent predictors of postoperative recurrence.
The study highlighted the favorable prognosis of pediatric DTC, with a low disease-specific mortality rate. However, the high recurrence rate underscores the need for close follow-up, particularly in younger patients and those with extrathyroidal extension. The recurrence rate in this study (28.6% at 10 years) is consistent with previous reports, which range from 20% to 47%. This high recurrence rate distinguishes pediatric DTC from adult DTC, where the 10-year recurrence rate is approximately 16.8%.
Younger age was strongly associated with higher recurrence rates, with patients aged 6.0–12.9 years experiencing significantly more recurrences than older age groups. This finding aligns with most previous studies, although some reports have failed to establish age as a risk factor. The study also observed a widening female-to-male ratio with increasing age, suggesting potential sex-specific influences on thyroid cancer development and progression in children and adolescents.
Extrathyroidal extension emerged as a critical risk factor for recurrence, consistent with findings from other studies. Patients with extrathyroidal extension were more likely to benefit from postoperative 131I therapy, highlighting the importance of adjuvant treatment in this subgroup. The study also noted that total thyroidectomy was associated with lower recurrence rates in patients aged 12 years and older, although the extent of thyroidectomy remains a controversial topic in pediatric DTC management.
The study’s limitations include its retrospective design and the potential for selection bias due to the exclusion of patients with incomplete data or prior treatment at other hospitals. Additionally, the small number of patients with certain pathological features, such as vascular tumor thrombus, limited the statistical power to detect significant associations.
In conclusion, pediatric DTC has a favorable prognosis but a high recurrence rate, particularly in younger patients and those with extrathyroidal extension. Aggressive treatment strategies, including total thyroidectomy and postoperative 131I therapy, are recommended for high-risk patients. Close follow-up is essential to detect and manage recurrences promptly. Future studies should explore the impact of total thyroidectomy in younger patient groups and investigate the role of molecular markers in predicting recurrence and guiding treatment decisions.
doi.org/10.1097/CM9.0000000000000910
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