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Pediatric Differentiated Thyroid Carcinoma in The Netherlands: A Nationwide Follow-Up Study
Mariëlle S Klein Hesselink1, Marloes Nies1, Gianni Bocca1
1Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
Insights
Pediatric differentiated thyroid carcinoma (DTC) shows excellent survival rates. However, lifelong postoperative complications are frequent, highlighting the need to minimize treatment-related morbidity in children with DTC.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Surgical Outcomes
Background:
- Treatment protocols for pediatric differentiated thyroid carcinoma (DTC) often rely on adult data due to limited pediatric studies.
- There is a need to understand the specific presentation, complications, and long-term outcomes in children with DTC.
Purpose of the Study:
- To evaluate the presentation, treatment-related complications, and long-term outcomes of pediatric DTC patients in The Netherlands.
- To identify areas for improving care and minimizing morbidity in young DTC patients.
Main Methods:
- A nationwide study analyzing medical records of pediatric DTC patients (age ≤18 years) treated between 1970 and 2013.
- Data collected included patient demographics, disease presentation, treatment modalities (thyroidectomy, radioiodine), postoperative complications, and disease recurrence.
Main Results:
- Overall survival was high (99.4%) with a median follow-up of 13.5 years.
- 32.4% of patients experienced lifelong postoperative complications, such as permanent hypoparathyroidism or recurrent laryngeal nerve injury.
- Disease persistence was observed in 8.6% and recurrence in 7.6% of patients.
Conclusions:
- Pediatric DTC has an excellent survival prognosis.
- Minimizing treatment-related morbidity is a critical priority in managing pediatric DTC.
- Centralization of care may help reduce adverse effects and improve outcomes for children with DTC.
Introduction:
Treatment for differentiated thyroid carcinoma (DTC) in pediatric patients is based mainly on evidence from adult series due to lack of data from pediatric cohorts. Our objective was to evaluate presentation, treatment-related complications, and long-term outcome in patients with pediatric DTC in The Netherlands.
Patients And Methods:
In this nationwide study, presentation, complications, and outcome of patients with pediatric DTC (age at diagnosis ≤18 y) treated in The Netherlands between 1970 and 2013 were assessed using medical records.
Results:
We identified 170 patients. Overall survival was 99.4% after a median follow-up of 13.5 years (range 0.3-44.7 y). Extensive follow-up data were available for 105 patients (83.8% women), treated in 39 hospitals. Median age at diagnosis was 15.6 years (range 5.8-18.9 y). At initial diagnosis, 43.8% of the patients had cervical lymph node metastases; 13.3% had distant metastases. All patients underwent total thyroidectomy. Radioiodine was administered to 97.1%, with a median cumulative activity of 5.66 GBq (range 0.74-35.15 GBq). Life-long postoperative complications (permanent hypoparathyroidism and/or recurrent laryngeal nerve injury) were present in 32.4% of the patients. At last known follow-up, 8.6% of the patients had persistent disease and 7.6% experienced a recurrence. TSH suppression was not associated with recurrences (odds ratio 2.00, 95% confidence interval 0.78-5.17, P = .152).
Conclusions:
Survival of pediatric DTC is excellent. Therefore, minimizing treatment-related morbidity takes major priority. Our study shows a frequent occurrence of life-long postoperative complications. Adverse effects may be reduced by the centralization of care, which is crucial for children with DTC.
