PAPILLARY THYROID CARCINOMA IN CHILDREN AND ADOLESCENTS, RESULTS OF TREATMENT OF 215 PATIENTS: FACTORS PREDICTING DISTANT METASTASES AND RECURRENCE OF THE DISEASE

Abstract

We evaluated the results of treatment of 215 pediatric patients with papillary thyroid carcinoma (PTC). Median age at diagnosis was 14 (5 - 18 y.o). Thyroidectomy performed in 105, subtotalthyroidectomy in 8, lobectomy - in 102, additional lymph node dissection - in 169, radioiodine ablation/ therapy - in 102 patients. Follicular variant PTC was found in 41 (19%), solid - in 37 (17%), diffuse sclerosing - in 3 (1%), the remaining had a classical PTC with mainly papillary (90; 42%) or follicular (44; 21%) pattern. 21% had multifocal PTC, 4,6% - extrathyroidal extension, 62% - regional lymph node metastases, 12% - lung metastases. The follow up was 95 months (6 - 301 mo). All patients are alive. Recurrence of PTC occurred in 37 (17%): 7 - thyroid remnant, 26 - cervical lymph nodes, 4 - distant lung metastases. Prognostic factors for distant metastases were young age at diagnosis <12 years old (OR 3.4, р <0.022), tumor size more then 3 cm (OR 3.2, р <0.027) and lateral cervical lymph node metastases (OR 21.39, р <0.0001). Risk of recurrence was higher in multifocal PTC (OR 2.4, р <0.009), regional lymph node metastases (OR 7.4, р <0,008) and distant metastases (OR 3.2, р <0,01). The highest risk of relapse had the patients with solid variant of PTC. Radical surgery diminished the risk of relapse (OR 0.3, р <0.002). There was no evidence of impact of radioiodine therapy on risk of recurrence (р=0.66).