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Young age is associated with increased rates of residual and recurrent paediatric differentiated thyroid carcinoma
Sarah Hampson1, Derek Stephens2, Jonathan D Wasserman3,4
1University of Toronto Medical School, Toronto, ON, Canada.
Insights
Younger children with differentiated thyroid carcinoma have worse outcomes than adolescents, despite similar initial treatment. This suggests a need for intensified therapy or closer surveillance in younger pediatric patients.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Thyroid Cancer Research
Background:
- Differentiated thyroid carcinoma is uncommon in young children.
- Existing data conflict on whether pediatric thyroid cancer is more aggressive in younger children compared to adolescents.
- Current treatment guidelines do not differentiate based on age, though differences are suspected.
Purpose of the Study:
- To compare clinical features, treatment, and outcomes of thyroid nodules and malignancy in children (<12 years) versus adolescents (12-18 years).
- To investigate potential age-related differences in thyroid cancer aggressiveness and response to therapy.
Main Methods:
- Retrospective case series conducted at a single tertiary care hospital.
- Analysis of 177 patients aged 0-18 years diagnosed with thyroid nodules or malignancy between 1992 and 2012.
- Comparison of demographic, clinical, treatment, and outcome data between younger children and adolescents.
Main Results:
- A higher female-to-male ratio was observed in adolescents (12-18 years) with benign and malignant nodules.
- No significant differences were found in cytology, histology, tumor size, surgical approach, or nodal status between age groups.
- Younger children exhibited a higher lymph node ratio, received higher radioactive iodine doses, and had a trend towards more pulmonary metastatic disease, with fewer achieving undetectable disease and remaining disease-free.
Conclusions:
- Younger children with differentiated thyroid carcinoma experience poorer outcomes compared to adolescents, even without nodal metastases.
- These findings suggest that younger pediatric patients may benefit from intensified primary therapy or enhanced tumor surveillance protocols.
- Age-specific treatment strategies may be warranted for differentiated thyroid carcinoma in pediatric populations.
Objective:
Differentiated thyroid carcinoma is rare in young children. There are conflicting data as to whether disease in this age group differs from that in adolescents and specifically, if it is more aggressive. Current practice guidelines do not differentiate treatment between these groups, but speculate that differences may exist. We sought to compare clinical features, treatment and outcomes between children (<12 years) and adolescents (12-18 years) with thyroid nodules and thyroid malignancy over a 20-year period.
Design:
Retrospective case series at a single tertiary care hospital.
Patients:
A total of 177 children 0-18 years of age at the time of diagnosis of a thyroid nodule and/or malignancy between 1992 and 2012.
Results:
There was a significantly higher female-to-male ratio in patients 12-18 years with benign and malignant nodules compared to those under 12. There was no difference across age groups with respect to cytology or histology, size, surgical approach or nodal status. Younger patients had a higher lymph node ratio. Younger patients received a higher cumulative dose of radioactive iodine (97.6 mCi/m2 ) vs older patients (75.9 mCi/m2 ) and had higher rates of pulmonary metastatic disease, although the differences did not achieve significance. Finally, children were less likely than adolescents to achieve a state of undetectable disease and fewer of the younger children remained disease-free.
Conclusions:
Despite comparable apparent initial disease burden and treatment, younger children have poorer outcomes when compared to adolescents, even in the absence of nodal metastases and thus may warrant intensification of primary therapy and/or tumour surveillance.
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