Abstract
BackgroundThe incidence of papillary thyroid carcinoma (PTC) in children and adolescents has increased, but the data on long-term outcomes are limited. There are few literatures on the clinicopathological characteristics and prognosis of PTC in children and adolescents in China. Therefore, it is necessary to identify clinicopathological features to precisely predict clinical prognosis and to help choose the optimal method and perform the best therapeutic regimen.MethodsThis study was a retrospective analysis of patients undergoing thyroidectomy at Tianjin Medical University Cancer Institute and Hospital. We analyzed the factors related to the clinicopathological features and prognosis of PTC in children and adolescents.ResultsA total of 95 juvenile PTC patients who underwent thyroidectomy were enrolled. Our research found that patients with younger age (<14 years) were predominantly multifocal and have positive preoperative thyroglobulin (Tg) and higher recurrence rate, and their number of lymph node metastases (LNMs) was more than that of the older group (14–18 years). Maximal tumor size >2 cm, T stage, and multifocality were the risk factors for LNM and the number of LNM (p < 0.05). Multivariate analysis displayed the number of central LNM as the independent risk factor for lateral LNM, and multifocality was the independent risk factor for the number of central and lateral LNM. Younger age at diagnosis, positive preoperative thyroid-stimulating hormone (TSH), maximal tumor size >2 cm, lateral LNM, number of LNM, N staging, and American Thyroid Association (ATA) pediatric risk were related to poor prognosis in PTC patients (p < 0.05). Cox regression analysis found that younger age at diagnosis and positive preoperative TSH were independent risk factors for recurrence of PTC in children and adolescents.ConclusionsOur study showed that the clinicopathological characteristics of younger age compared with older age were as follows: highly aggressive, prone to metastases, and higher recurrence rate. In our opinion, patients with characteristics such as younger age at diagnosis, positive preoperative TSH, maximal tumor size >2 cm, lateral LNM, and number of LNM >5 may be considered for prophylactic or therapeutic dissection of additional metastatic LNs by high-volume surgeons to prevent and reduce the recurrence rate of patients during long-term follow-up.
Highlights
Thyroid carcinoma is rare in children and adolescents, but the occurrence has been steadily rising worldwide in the past decades [1, 2]
The results showed that age at diagnosis, positive preoperative thyroid-stimulating hormone (TSH), maximal tumor size >2 cm, lateral lymph node metastases (LNM), number of LNM >5, N stage, and American Thyroid Association (ATA) pediatric risk were associated with poor prognosis in Papillary thyroid carcinoma (PTC) patients with statistical significance (p < 0.05)
Our study found that maximal tumor size >2 cm and T stage were associated with central LNM (p < 0.05) and that maximal tumor size >2 cm, T stage, number of central LNM, and multifocality were the risk factors related to lateral LNM (p < 0.05), consistent with the report of the present study [18, 19]
Summary
Thyroid carcinoma is rare in children and adolescents, but the occurrence has been steadily rising worldwide in the past decades [1, 2]. Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer in children and adolescents, which accounts for 90% [3, 4]. A second operation for relapsed patients has a great impact on the quality of life of children and adolescents with PTC. In this setting, optimal treatment strategies for children and adolescents with PTC remain controversial. PTC in children and adolescents has an increasing incidence, but long-term prognosis data are limited. Thence, recording the prognosis and identifying the predictors of PTC recurrence are of great clinical value in this age group. The incidence of papillary thyroid carcinoma (PTC) in children and adolescents has increased, but the data on long-term outcomes are limited. It is necessary to identify clinicopathological features to precisely predict clinical prognosis and to help choose the optimal method and perform the best therapeutic regimen
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