Practical Initial Risk Stratification Based on Lymph Node Metastases in Pediatric and Adolescent Differentiated...

Area of Science:

• Pediatric Oncology
• Endocrinology
• Cancer Research

Background:

• Limited data exists on risk stratification for pediatric differentiated thyroid cancer (DTC).
• Accurate risk assessment is crucial for managing pediatric DTC patients effectively.

Purpose of the Study:

• To identify predictors of persistent or recurrent disease in pediatric DTC.
• To revise and validate an initial risk-stratification system for pediatric DTC.

Main Methods:

• Retrospective cohort study of 203 pediatric patients (<20 years) with DTC from two Korean tertiary centers.
• Classification of cervical lymph node (LN) metastasis based on location and number.
• Analysis of extrathyroidal extension (ETE) and LN metastasis extent for risk stratification.

Main Results:

• Structural persistent/recurrent disease occurred in 25% of patients over a median 5.5-year follow-up.
• Extrathyroidal extension (ETE) and lateral cervical LN metastasis (or >5 metastatic LNs) predicted persistent/recurrent disease.
• Bilateral lateral cervical LN metastases (or >10 metastatic LNs) predicted distant metastasis.
• A revised system using ETE and LN metastasis extent stratified patients into low, intermediate, and high-risk groups with significantly different recurrence risks.

Conclusions:

• A revised risk-stratification system incorporating ETE and cervical LN metastasis extent is effective for predicting pediatric DTC outcomes.
• This system can aid in the practical management and clinical decision-making for pediatric DTC.
• Further validation of this refined risk-stratification approach is recommended.