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Published on: June 9, 2023
Pathologic Characteristics and Surgical Outcomes of Pediatric Versus Adult Well-Differentiated Thyroid Cancer
Shivee Gilja1, Arvind Kumar1, Aldo V Londino1
1Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
Insights
Pediatric differentiated thyroid cancer (DTC) presents more aggressively than adult DTC, leading to more extensive treatment and poorer short-term surgical outcomes. This highlights the need for specialized, multidisciplinary care for pediatric DTC patients.
Area of Science:
- Oncology
- Pediatric Surgery
- Cancer Research
Background:
- Pediatric differentiated thyroid cancer (DTC) incidence is rising.
- Postoperative outcomes for pediatric DTC are not well-characterized.
- Comparison between pediatric and adult DTC outcomes is needed.
Purpose of the Study:
- To compare pathologic tumor characteristics between pediatric and adult DTC patients.
- To compare treatment outcomes for pediatric and adult DTC patients.
- To evaluate short-term surgical outcomes in pediatric versus adult DTC.
Main Methods:
- Retrospective case-control study utilizing the National Cancer Database (2004-2020).
- Inclusion of pediatric (<18 years) and adult (≥18 years) patients who underwent surgery for DTC.
- Application of multivariable logistic, negative binomial, and linear regressions for outcome comparison.
Main Results:
- Pediatric DTC patients showed higher rates of pathologic T upstaging, N upstaging, and extrathyroidal extension compared to adults.
- Pediatric patients were more likely to receive neck dissection and radioactive iodine treatment.
- Higher rates of positive surgical margins and 30-day readmissions were observed in pediatric patients.
Conclusions:
- Pediatric DTC is associated with more aggressive disease presentation and more radical treatment.
- Pediatric DTC patients experience worse short-term surgical outcomes compared to adults.
- Pediatric DTC warrants consideration as a unique clinical entity requiring specialized, multidisciplinary management.
Objective:
Despite the rising incidence of pediatric differentiated thyroid cancer (DTC), postoperative outcomes for such tumors have not been well-characterized. The objective of this study was to compare pathologic tumor characteristics and treatment outcomes for pediatric and adult patients with DTC.
Study Design:
Retrospective case-control study.
Setting:
National database.
Methods:
Pediatric (<18 years old) and adult (≥18 years old) patients who underwent surgery for DTC in the National Cancer Database (2004-2020) were included. Multivariable logistic, negative binomial, and linear regressions were used to compare pathologic tumor characteristics, treatment characteristics, and short-term surgical outcomes.
Results:
337,864 patients with DTC met the study eligibility criteria; 3584 (1.1%) were pediatric patients and 334,280 (98.9%) were adults. After adjustment, pediatric patients were found to have higher rates of pathologic T upstaging (adjusted odds ratio [ORadj]: 1.40, 95% confidence interval [CI]: 1.23-1.59), N upstaging (ORadj: 2.53, 95% CI: 2.23-2.88), and extrathyroidal extension (ORadj: 1.58, 95% CI: 1.29-1.94), compared to adult patients. Pediatric patients were also more likely to receive neck dissection (ORadj: 2.80, 95% CI: 2.55-3.07) and radioactive iodine (ORadj: 1.42, 95% CI: 1.30-1.55). Pediatric patients had higher rates of positive surgical margins (ORadj: 1.25, 95% CI: 1.11-1.41) and 30-day readmissions (ORadj: 1.26, 95% CI: 1.00-1.58) than adult patients.
Conclusion:
These findings demonstrate that pediatric DTC is associated with more aggressive disease presentations, more radical treatment, and worse short-term surgical outcomes compared to DTC in adults. Pediatric DTC should be considered a unique clinical entity that requires personalized evaluation and multidisciplinary treatment by specialized providers.
