Younger children with thyroid carcinoma have more advanced disease than adolescents
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Children aged 10 years or younger with papillary thyroid carcinoma are more likely to have more advanced disease at diagnosis than adolescents or young adults, according to a study published in Thyroid.
“This analysis of pediatric papillary thyroid carcinomas is a cohort study that captures approximately 70% of all pediatric thyroid cancer diagnoses in the U.S. and characterizes the association between patient age with respect to onset of puberty and presenting stage of disease,” Jessica W. Thiesmeyer, MD, resident physician in the department of surgery at Weill Cornell Medical College and NewYork-Presbyterian Hospital, and colleagues wrote. “It is the largest study of pediatric papillary thyroid carcinoma since the Belarusian analysis, which found that younger age at diagnosis in patients with a history of ionizing radiation was associated with recurrent nodal disease and pulmonary metastasis. We report a spectrum of disease severity for pediatric papillary thyroid carcinoma, wherein prepubertal children present with the most extensive disease and young adults present most favorably, with adolescents assuming an intermediate profile.”
Researchers extracted data from the National Cancer Database in the U.S. of pediatric patients aged 18 years and younger and young adults aged 19 to 39 years diagnosed with papillary thyroid carcinoma from 2004 to 2017. Patients were categorized as prepubertal if they were aged 10 years or younger and adolescents if they were aged 11 to 18 years. Patient demographics, cancer staging, treatment and overall survival were collected. Lymphovascular invasion was reported from 2010 to 2017 and extrathyroidal extraction was reported from 2004 to 2015. Tumor characteristics, treatment methods and outcomes were compared between the age groups.
There were 106,019 people included in the study, of whom 101,159 were young adults (mean age, 32 years; 82.6% women), 4,586 were adolescents (mean age, 16 years; 82% girls) and 274 were prepubertal children (mean age, 9 years; 64.6% girls).
Prepubertal children had a higher proportion of patients with a primary tumor size of larger than 4 cm (22.6%) than the adolescent group (13.5%) and the young adult group (8.3%; P < .001). The Prepubertal group more frequently presented with lymphovascular invasion (57.8% vs. 36.1%; P < .001) and gross extrathyroidal extension (47.4% vs. 24.9%; P < .001) than the adolescent group.
Regional lymph nodes were diagnosed more frequently in prepubertal children (67.2%) than adolescents (52.3%) and young adults (32.1%). There was also a higher proportion of distant metastatic disease diagnoses in the prepubertal group (11.3%) compared with adolescents (2.2%) and young adults (0.5%). In a multivariable regression model, prepubertal children were more likely to be diagnosed with regional lymph nodes (adjusted OR = 1.36; 95% CI, 1.01-1.84; P = .04) and distant metastatic disease (aOR = 3.12; 95% CI, 1.96-4.96; P < .001) than adolescents. The findings were similar in a secondary analysis of patients with small tumors of 10 mm of less in size, as prepubertal children continued to have a greater likelihood for regional lymph node metastases than adolescents (aOR = 2.19; 95% CI, 1.1-4.36; P = .03).
Most pediatric patients underwent a total thyroidectomy, though 7.2% of adolescents had a hemithyroidectomy compared with 4% of prepubertal children (P = .001). A lower proportion of prepubertal children underwent a prophylactic lymphadenectomy compared with adolescents (18.6% vs. 30%), but a higher proportion of prepubertal youth underwent a therapeutic lymphadenectomy compared with the adolescent group (31% vs. 19.6%; P < .001) and young adult group (31% vs. 18.2%; P < .001).
There was no difference in 5-year survival between the age groups, with all three recording a survival rate of higher than 99%.
“Additional research is needed to determine whether adolescent patients may be safely managed less conservatively than younger children with papillary thyroid carcinoma, and to further elucidate the specific molecular derangements that underlie this divergence in presentation,” the researchers wrote.
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