Multifocal thyroid carcinoma less common in children, not linked to worse outcomes
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Key takeaways:
- Multifocal disease is more common in adults than children with papillary thyroid carcinoma.
- Youths with multifocal disease have similar long-term outcomes as those with unifocal disease.
Multifocal disease is not linked to a greater risk of recurrence or mortality for children and adolescents with papillary thyroid carcinoma, according to a study published in The Journal of Clinical Endocrinology & Metabolism.
In findings from a single-center study, children with papillary thyroid carcinoma were less likely to have multifocal disease than adults and had similar outcomes compared with children with unifocal disease. The findings support more conservative treatment, according to Ian Ganly, MD, PhD, professor of head and neck surgery at Memorial Sloan Kettering Cancer Center in New York and professor of otolaryngology, head and neck surgery at Weill Medical College, Cornell University.
“In children who were treated with thyroid lobectomy in our institution and found to have multifocality, we chose to observe these children rather than doing further surgery with completion thyroidectomy,” Ganly told Healio. “These children did not have an increased rate of recurrence compared to children who had unifocal papillary thyroid carcinoma. This justifies our conservative approach to treating children with thyroid lobectomy rather than total thyroidectomy.”
Ganly and colleagues conducted a retrospective review of people who underwent surgery for thyroid cancer from 1986 to 2021 at Memorial Sloan Kettering Cancer Center. Data were extracted from the center’s database. Researchers calculated recurrence-free probability, disease-specific survival and overall survival in months from the date of surgery. Follow-up continued until the last office visit with a member of the institution’s disease management team.
There were 299 children and adolescents aged 21 years or younger and 5,775 adults included in the study. Of participants who had focality reported, multifocal disease was more common in adults compared with children and adolescents (54% vs. 45%; P = .002).
“It was previously thought that children with papillary thyroid carcinoma had a high incidence of multifocality,” Ganly said. “This was partly responsible for the recommendation for children with papillary thyroid carcinoma to be treated with total thyroidectomy. This of course means lifelong replacement HT with [levothyroxine]. Our data actually shows multifocality is in fact less common in children compared to adults.”
Children and adolescents with papillary thyroid carcinoma were followed for a median of 68 months. In multivariable analysis, there were no factors associated with an increased risk for worse recurrence-free survival. Multifocal disease was not linked to an increased risk for recurrence.
Of children and adolescents included in the study, 22% were treated with a thyroid lobectomy. Of that group, 24% had multifocal disease and 76% had unifocal disease. Among those treated with a lobectomy, recurrence rates were similar with multifocal disease and unifocal disease. No distant recurrence occurred in either group. Both the unifocal and multifocal groups had a 5-year and 10-year overall survival of 100%.
“Moving forward we would need large cohort studies from other institutions to validate our findings,” Ganly said.
For more information:
Ian Ganly, MD, PhD, can be reached at ganlyi@mskcc.org.
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