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Published on: June 2, 2023
Age Stratification and Prognostic Factor Analysis in Pediatric Differentiated Thyroid Cancer
Ophir Winder1, Liora Lazar2, Roy Hod1
1Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center and Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
Insights
Younger children diagnosed with differentiated thyroid cancer (DTC) exhibit more aggressive disease features and lower early remission rates. However, long-term outcomes for pediatric DTC patients remain favorable.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Cancer Research
Background:
- Differentiated thyroid cancer (DTC) is uncommon in children.
- The relationship between age at diagnosis and disease aggressiveness in pediatric DTC is not fully understood.
- Identifying prognostic factors is crucial for tailoring treatment and improving outcomes.
Purpose of the Study:
- To identify prognostic factors for aggressive pediatric DTC.
- To define appropriate age stratification for risk assessment in pediatric DTC.
- To evaluate the impact of age on disease aggressiveness and treatment outcomes.
Main Methods:
- Retrospective cohort study of pediatric patients (≤18 years) treated for DTC between 1985 and 2021.
- Minimum follow-up of 1.5 years post-treatment.
- Analysis of American Thyroid Association (ATA) risk stratification, histopathologic features, and disease progression by age.
Main Results:
- Younger patients (<11 years) showed more aggressive disease features, including higher ATA risk and metastatic disease.
- Children under 11 had a significantly higher rate of disease evidence at 1 year post-treatment (66.7% vs. 25.4%).
- Patients under 8 years had more frequent bilateral disease and extrathyroidal extension.
Conclusions:
- Pediatric DTC patients diagnosed before age 11 present with more aggressive disease and lower early remission rates.
- Despite initial challenges, long-term outcomes for pediatric DTC patients are generally satisfactory.
- Age at diagnosis is a significant factor influencing disease behavior in pediatric DTC.
Objectives:
Differentiated thyroid cancer (DTC) is rare in the pediatric population. It remains unclear whether younger children are at greater risk of more aggressive disease. We aimed to identify prognostic factors for aggressive pediatric DTC and to define an appropriate age stratification.
Methods:
This retrospective cohort study included all patients aged 18 years or less who were treated for DTC between 1985 and 2021 in a tertiary medical center and were followed up for a minimum of 1.5 years after treatment.
Results:
Seventy-eight patients were included, all diagnosed with papillary thyroid carcinoma: 30 (38.5%) low-risk, 21 (26.9%) intermediate-risk, and 27 (34.6%) high-risk according to the American Thyroid Association (ATA) risk stratification. The mean duration of follow-up was 11.8 ± 7.8 years. No evidence of disease was documented in 52 patients (66.7%) at 1-year post-treatment and 64 patients (82.1%) at the end of follow-up. On analysis by age, evidence of disease at 1-year post-treatment was found in 66.7% of children younger than 11 years, compared to 25.4% of older children (p = 0.002). There was no significant difference by age in evidence of disease at the last follow-up (p = 0.453). Patients aged <11 years at diagnosis were associated with more aggressive disease features on histopathologic examination, metastatic disease, and high ATA risk level. Patients aged <8 years were associated with more frequent bilateral disease and extrathyroidal extension.
Conclusion:
Pediatric DTC patients who are younger than 11 years at diagnosis have more aggressive disease features and a lower early remission rate than older patients. Nevertheless, their long-term outcome is satisfactory.
Level Of Evidence:
4-retrospective cohort study Laryngoscope, 134:4818-4825, 2024.
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