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Tumor size is an independent negative prognostic factor for event free survival in children with differentiated
Sandeep Kumar Parvathareddy1, Abdul K Siraj1, Padmanaban Annaiyappanaidu1
1Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Insights
Pediatric differentiated thyroid carcinoma (DTC) shows increasing incidence but excellent prognosis. Tumor size over 4cm and distant metastasis are key factors negatively impacting event-free survival (EFS) in Middle Eastern children.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Cancer Research
Background:
- Pediatric differentiated thyroid carcinoma (DTC) incidence is rising globally.
- Despite often advanced presentation, pediatric DTC generally has an excellent prognosis.
- Understanding risk factors is crucial for optimizing outcomes in this population.
Purpose of the Study:
- To identify prognostic factors for event-free survival (EFS) in pediatric DTC patients of Middle Eastern ethnicity.
- To evaluate the impact of specific clinical and pathological features on EFS.
- To refine risk stratification for improved management strategies.
Main Methods:
- Retrospective analysis of 88 pediatric DTC patients (age ≤18 years).
- Utilized Cox proportional hazards models and Kaplan-Meier analysis to assess EFS.
- Investigated factors including lymph node metastasis, distant metastasis, and tumor size.
Main Results:
- The study included 88 pediatric DTC patients, with 70.5% having lymph node metastasis and 13.6% distant metastasis.
- Ten-year EFS was 79.2%, negatively impacted by lymph node metastasis, distant metastasis, and tumor size >4cm.
- Multivariate analysis identified tumor size >4cm (HR=5.34) and distant metastasis (HR=8.73) as independent negative prognostic factors for EFS.
Conclusions:
- Primary tumor size >4cm and distant metastasis are independent prognostic factors for EFS in pediatric DTC of Middle Eastern ethnicity.
- These findings highlight the need for tailored treatment and closer follow-up for children with larger tumors or distant spread.
- Current risk stratification models may require refinement for this specific demographic.
Background:
The incidence of pediatric differentiated thyroid carcinoma (DTC) is increasing. Despite the advanced disease at presentation, the overall prognosis of DTC in children is excellent. The aim of this study is to investigate the risk stratifying factors for event free survival (EFS) of pediatric DTC from Middle Eastern ethnicity.
Methods:
Eighty-eight patients aged ≤18 years with diagnosis of primary DTC were retrospectively analyzed. Cox proportional hazards model were used to calculate Hazard Ratios (HR) and Kaplan-Meier analysis were conducted to investigate EFS.
Results:
Eighty-eight (23 males and 65 females) pediatric DTCs who underwent surgery and radioactive iodine therapy had been reported (median age at diagnosis 15 years; range 5.9-17.9), with lymph node metastasis (LNM) noted in 70.5% and distant metastasis in 13.6%. Mean follow-up was 8.4 years. Ten-year overall survival rate was 98.4% while 10-year EFS was 79.2%. EFS was negatively impacted by the presence of LNM, distant metastasis and tumor size >4cm. American Thyroid Association risk stratification did not impact EFS in our cohort. Multivariate analysis revealed tumor size >4cm (HR = 5.34; 95% confidence interval (CI) = 1.36 - 20.22; p = 0.0177) and distant metastasis (HR = 8.73; 95% CI = 1.48 - 60.05; p = 0.0154) as independent negative prognostic factors for EFS.
Conclusions:
Primary tumor size and the presence of distant metastasis at diagnosis are the only independent prognostic risk factors for EFS in pediatric DTC in Middle Eastern ethnicity. Children with tumor size over 4cm had poor EFS, which may justify the need of more aggressive treatment and frequent follow-up.
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