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Published on: June 9, 2023
Distant Metastases and Outcome of Pediatric Differentiated Thyroid Cancer
Ali S Alzahrani1, Ghada Alskait1, Yasser Aljufan1
1Department of Medicine, King Faisal Specialist Hospital and Research Centre, P. O. Box 3354, Riyadh 11211, Saudi Arabia.
Insights
Distant metastases are common in pediatric differentiated thyroid cancer (DTC), particularly with larger tumors and extrathyroidal extension. These metastases are the primary predictor of persistent or recurrent disease in young patients.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Nuclear Medicine
Background:
- Differentiated thyroid cancer (DTC) in children and adolescents can present with distant metastases.
- Understanding predictors of metastasis is crucial for effective management and prognosis.
Purpose of the Study:
- To identify factors predicting distant metastases in pediatric DTC.
- To evaluate the impact of distant metastases on treatment outcomes in pediatric DTC.
Main Methods:
- Retrospective analysis of 192 pediatric DTC patients (age ≤ 18 years) treated over 21 years.
- Evaluation of clinical data, treatment modalities (thyroidectomy, radioactive iodine), and outcomes.
- Multivariate analysis to determine predictors of distant metastases and persistent/recurrent disease.
Main Results:
- 18.2% of patients developed distant metastases.
- Tumor size and extrathyroidal extension were significant predictors of distant metastases.
- Distant metastases were the strongest predictor of persistent/recurrent disease (OR 8.9, P < .0001).
Conclusions:
- Pediatric DTC with large tumor size and extrathyroidal extension has a higher risk of distant metastases.
- Distant metastases are the most critical factor influencing the persistence or recurrence of pediatric DTC.
Context:
Distant metastases are fairly common in pediatric differentiated thyroid cancer (DTC).
Objective:
Our objectives were to study the predictive factors of distant metastases and the outcome of pediatric DTC.
Methods:
We studied all patients with pediatric DTC (age ≤ 18 years) managed over 21 years (January 2002-December 2022) at our institution. A total of 192 patients (33 males [17.2%], 159 females [82.8%]) with pediatric DTC were analyzed. The median age was 16 years (range, 5-18 years). Total thyroidectomy was performed in 97%, lymph node dissection in 86.4%, and radioactive iodine-131 (I-131) ablation/therapy was administered to 85.4% of the patients. Additional therapies were administered to 65 patients (33.9%). Thirty-five patients (18.2%) developed distant metastases.
Results:
At the last follow-up (median follow-up, 82.5 months; interquartile range 48-132), 124 patients (64.6%) had an excellent response, 47 (24.5%) had an indeterminate response, 5 (2.6%) were in a biochemically incomplete response, 15 (7.8%) were in a structurally incomplete response, and 1 patient (0.5%) died of thyroid cancer. While tumor size, extrathyroidal extension/invasion, and distant metastases were predictive of persistent/recurrent disease in a univariate analysis, only distant metastases remained consistently predictive of persistent/recurrent disease in a multivariate analysis (P < .0001; odds ratio 8.9; 95% CI, 3.2-25.0). In a multivariate analysis, predictors of distant metastases were tumor size (P = .004; odds ratio 1.41; 95% CI, 1.11-1.76) and extrathyroidal extension (P = .001; odds ratio 13.7; 95% CI, 3.1-60.6).
Conclusion:
In pediatric DTC, distant metastases are common, especially in patients with large tumor size and extrathyroidal extension. Distant metastases are the most important predictive factor of persistent/recurrent disease.
