Papillary Thyroid Carcinoma in Children and Adolescents: Long-Term Follow-Up and Clinical Characteristics

Introduction

Age has been reported to be one of the most important prognostic factors in papillary thyroid carcinoma (PTC), and the prognosis has been reported to be better in young patients than in elderly patients. However, it is generally accepted that the clinical presentation of PTC in children and adolescent is different from its presentation in adults. Juvenile patient tends to present in the advanced stage, i.e., with a large primary tumor, and they have a high incidence of distant or locoregional metastatic spread. Since the prognosis of PTC in juvenile patients has been reported to be better than in adults despite these aggressive clinical characteristics, several recommendations have been made, which proposed a less aggressive therapeutic approach (less than total thyroidectomy and no neck dissection). By contrast, some researchers advise more aggressive therapy, including total thyroidectomy, neck dissection, and postoperative radioiodine ablation. The possibility of recurrent disease and locoregional spread is still a major clinical concern in regard to the optimal extent of initial surgical therapy. Several major studies have attempted to evaluate the impact of patient and tumor characteristics on clinical outcome, as well as of treatment factors, but there were no clear recommendations regarding possible risk factors for developing recurrent disease. We previously reported our experience with the treatment of child and adolescent PTC patients and concluded that preoperative lymph node metastasis (LNM) was an important prognostic factor. In the present study, we retrospectively investigated the clinical outcome of juvenile PTC patients who had been treated in our hospital and whether preoperative evaluation of the disease by recent high-resolution US has resulted in improved clinical staging. The aim of this study was to analyze the clinical features and clinical outcomes of papillary thyroid carcinoma (PTC) in the pediatric and adolescent population treated in our institution.

Methods

The subjects were 227 PTC patients 20 years of age or under treated initially between 1979 and 2012. Their mean age at diagnosis was 18-year old (range 7–20 years). Patient characteristics and outcomes in the period before 1999 and the period after 2000 were compared. Cause-specific survival (CSS) rates and disease-free survival (DFS) rates were calculated by the Kaplan–Meier method.

Results

Two patients died of their disease and 45 patients had recurrent disease (36 in lymph node, seven in a remnant thyroid, and 11 in the form of distant metastasis). The 10-, 20-, and 30-CSS rates were 99.3, 99.3, and 96.5 %, respectively, and the 10-, 20-, and 30-DFS were 83.6, 70.7, and 64.0 %, respectively. Gender and preoperative lymph node metastasis were identified as significant factors related to DFS in the multivariate analysis. After the year 2000, there were significantly more patients with a small primary tumor size, significantly more patients without distant metastasis at presentation and significantly more patients without extra thyroidal invasion.

Conclusion

The number of patients with advanced cancer has been declining in recent years. Lobectomy with prophylactic unilateral central neck dissection is considered acceptable for patients without the risk factors for recurrence.

Reference

Kiminori Sugino, Mitsuji Nagahama, Wataru Kitagawa, Hiroshi Shibuya, Keiko Ohkuwa, Takashi Uruno, “Papillary Thyroid Carcinoma in Children and Adolescents: Long-Term Follow-Up and Clinical Characteristics”, World J Surg., DOI 10.1007/s00268-015-3042-4, 2015.