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Pediatric differentiated thyroid carcinoma in stage I: risk factor analysis for disease free survival
Nobuyuki Wada1, Kiminori Sugino, Takashi Mimura
1Surgical Branch, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo 150-8308, Japan. wadan523@aol.com
Insights
Pediatric differentiated thyroid carcinoma (DTC) patients in TNM stage I have risk factors including male gender, advanced tumor stage, and lymphadenopathy. Aggressive treatment is recommended for high-risk patients, while others may benefit from a conservative approach.
Area of Science:
- Endocrinology
- Pediatric Oncology
- Surgical Oncology
Background:
- Pediatric differentiated thyroid carcinoma (DTC) presents unique challenges in TNM stage I, with controversial treatment strategies despite recurrence potential.
- Understanding risk factors is crucial for optimizing outcomes in young DTC patients.
Purpose of the Study:
- To identify outcomes and risk factors for disease-free survival (DFS) in pediatric patients with TNM stage I DTC.
- To inform treatment strategies for this specific patient cohort.
Main Methods:
- Retrospective review of 57 pediatric patients (≤15 years) with TNM stage I DTC treated between 1962 and 2004.
- Clinicopathological evaluation and multivariate analysis to determine risk factors for DFS.
Main Results:
- Male gender, advanced tumor stage (T3, 4a), and clinical lymphadenopathy were significant risk factors for DFS.
- 26.3% of patients experienced local recurrence, but no deaths occurred; 10/15 achieved disease-free status after further treatment.
- Pathological node metastasis was confirmed in 64.9% of patients.
Conclusions:
- Male gender, advanced tumor stage, and lymphadenopathy are key risk factors for DFS in pediatric stage I DTC.
- Aggressive treatment (total thyroidectomy, node dissection, radioactive iodine therapy) is advised for high-risk patients.
- A conservative or stepwise approach may be suitable for lower-risk pediatric DTC patients.
Background:
To examine the outcomes and risk factors in pediatric differentiated thyroid carcinoma (DTC) patients who were defined as TNM stage I because some patients develop disease recurrence but treatment strategy for such stage I pediatric patients is still controversial.
Methods:
We reviewed 57 consecutive TNM stage I patients (15 years or less) with DTC (46 papillary and 11 follicular) who underwent initial treatment at Ito Hospital between 1962 and 2004 (7 males and 50 females; mean age: 13.1 years; mean follow-up: 17.4 years). Clinicopathological results were evaluated in all patients. Multivariate analysis was performed to reveal the risk factors for disease-free survival (DFS) in these 57 patients.
Results:
Extrathyroid extension and clinical lymphadenopathy at diagnosis were found in 7 and 12 patients, respectively. Subtotal/total thyroidectomy was performed in 23 patients, modified neck dissection in 38, and radioactive iodine therapy in 10. Pathological node metastasis was confirmed in 37 patients (64.9%). Fifteen patients (26.3%) exhibited local recurrence and 3 of them also developed metachronous lung metastasis. Ten of these 15 achieved disease-free after further treatments and no patients died of disease. In multivariate analysis, male gender (p = 0.017), advanced tumor (T3, 4a) stage (p = 0.029), and clinical lymphadenopathy (p = 0.006) were risk factors for DFS in stage I pediatric patients.
Conclusion:
Male gender, tumor stage, and lymphadenopathy are risk factors for DFS in stage I pediatric DTC patients. Aggressive treatment (total thyroidectomy, node dissection, and RI therapy) is considered appropriate for patients with risk factors, whereas conservative or stepwise approach may be acceptable for other patients.
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