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Aggressiveness of Differentiated Thyroid Carcinoma in Pediatric Patients Younger Than 16 years: A Propensity
Soo Young Kim1, Hyeok Jun Yun2, Hojin Chang2
1Department of Surgery, Ajou University School of Medicine, Suwon, South Korea.
Insights
Pediatric differentiated thyroid cancer (DTC) shows more aggressive behavior than adult DTC. Pediatric patients experience more frequent lymph node metastasis and a higher recurrence rate, indicating a need for tailored treatment strategies.
Area of Science:
- Endocrinology
- Pediatric Oncology
- Surgical Oncology
Background:
- Pediatric differentiated thyroid cancer (DTC) exhibits distinct biological behavior compared to adult DTC.
- Understanding these differences is crucial for optimizing prognosis and clinical management in young patients.
Purpose of the Study:
- To compare the clinical presentation and outcomes of DTC in pediatric patients (<16 years) versus adult patients.
- To identify key differences that can inform tailored treatment approaches for pediatric DTC.
Main Methods:
- Retrospective analysis of 48 pediatric DTC patients (1992-2014).
- Propensity score-matched analysis comparing pediatric patients with adult patients (matched for sex and tumor size).
- Evaluation of surgical procedures, lymph node metastasis, distant metastasis, and recurrence rates.
Main Results:
- Pediatric DTC patients presented with more frequent central and lateral neck node metastases compared to matched adults.
- Symptoms were significantly more common in the pediatric cohort.
- Pediatric patients had a higher likelihood of recurrence (HR 5.339) and significantly worse recurrence-free survival (p = 0.0209).
Conclusions:
- Pediatric DTC demonstrates more aggressive characteristics than adult DTC, even with similar tumor size.
- Higher rates of lymph node metastasis and recurrence underscore the aggressive nature of pediatric DTC.
- Findings suggest distinct management strategies are necessary for pediatric DTC patients compared to adults.
Background:
The biological behavior of thyroid cancer in children has been known to be different from that in adults. We sought to understand the differences between DTC presentation in pediatric (<16 years) and adult patients, to guide better prognosis and clinical treatments.
Methods:
This retrospective study included 48 pediatric patients younger than 16 years who underwent initial thyroid surgery and were diagnosed with DTC between January 1992 and December 2014 at Yonsei University in Seoul, South Korea. For a 1:4 propensity score-matched analysis, adult patients with matched sex and cancer size were included.
Results:
The mean age was 12.54 ± 3.01 years. Total thyroidectomy (70.8%) without lateral lymph node dissection (47.9%) was the most commonly performed surgery. Central (73.9%) and lateral neck node metastases (62.5%) were common; distant metastasis was observed in 2 (4.2%) patients and recurrence occurred in 11 (22.9%). In propensity score-matched analysis, central lymph node metastasis and lateral neck node metastasis were significantly more frequent in pediatric patients. Symptoms were more common in the pediatric group than in the adult group (p < 0.001). In stratified cox regression, pediatric patients were more likely to experience recurrence [HR 5.339 (1.239-23.007)]. In stratified log-rank analysis, recurrence-free survival was significantly different between the adult and pediatric groups (p = 0.0209).
Conclusion:
DTC in the pediatric group revealed more aggressive patterns than in the adult group with the same cancer size. Central lymph node metastasis and lateral neck node metastasis were more frequent. Stratified log-rank analysis revealed that recurrence was significantly higher in pediatric patients than in matched adult patients.
