Patients Younger Than 11 Years with Differentiated Thyroid Cancer Have a More Aggressive Disease and Lower Early Remission Rate Than Older Children

CLINICAL QUESTION

What are the prognostic factors for aggressive pediatric differentiated thyroid cancer (DTC), and what is the age stratification in terms of risk for more aggressive disease?

BOTTOM LINE

Pediatric patients with DTC who are younger than 11 years at diagnosis have more aggressive disease features and a lower early remission rate than older patients, although their long-term outcome is satisfactory.

BACKGROUND: The incidence of pediatric DTC has more than doubled in the last 40 years. Compared to adults, DTC in children is more frequently bilateral and associated with extrathyroidal extension (ETE), nodal and pulmonary metastasis, and higher rates of recurrence. It remains unclear whether younger children are at greater risk of a more aggressive disease, however.

STUDY DESIGN: Retrospective cohort study

SETTING: Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center and Schneider Children’s Medical Center of Israel, Petah Tikva, Israel

SYNOPSIS: Researchers identified 78 patients (80.8% female; mean age 13.3 years) treated for DTC at a single institution between 1985 and 2021. All patients were diagnosed with papillary thyroid carcinoma: 30 low-risk, 21 intermediate-risk, and 27 high-risk. Fifteen patients were younger than 11 years old. Initial treatment was based on surgery, with radioactive iodine treatment, when indicated, delivered four to six weeks later. Results were analyzed at one and two years post-treatment and again at the end of the follow-up period (mean duration 11.8 years). By follow-up, no evidence of disease was documented in 64 patients (82.1%). On analysis by age, evidence of disease at one year was found in 66.7% of children under 11 years old, compared to 25.4% of older children. By the last follow-up, however, there was no significant difference by age in evidence of disease. Patients aged 11 years or younger at diagnosis were associated with more aggressive disease features on histopathologic examination, metastatic disease, and high-risk level. Patients aged eight years or younger were associated with more frequent bilateral disease and ETE. The authors say their findings suggest that a standardized approach to managing pediatric patients with DTC may not be appropriate. Study limitations included its retrospective nature.

CITATION: Winder O, et al. Age stratification and prognostic factor analysis in pediatric differentiated thyroid cancer. Laryngoscope. 2024;134:4818-4825. doi: 10.1002/lary.31592.