Clinical Characteristics And Prognostic Factors Of Differentiated Thyroid Cancer In Children And Adolescents

BackgroundDifferentiated thyroid carcinoma(DTC)is rare in children and adolescents with only 0.2%?1% children suffering from thyroid carcinoma,but its incidence is on the rise.The pathological pattern includes: papillary thyroid carcinoma(PTC)and follicular thyroid carcinoma(FTC).There are significant clinical,pathological,and molecular differences between pediatric and adult patients.Compared with adults,DTC in children and adolescents are more aggressive,with more frequent lymph node and distant metastases,higher risk of postoperative recurrence as well.However,the prognosis and therapeutic effects of children and adolescents with DTC are desirable,and the mortality is relatively low.At present,taking advantage of individualized and comprehensive therapy like surgery,Iodine-131 and TSH suppressive therapy,children and adolescents with DTC can obtain long-term disease remission.Long-term follow-up after surgery is very important for children and adolescents with DTC,but the predictors of the risk of recurrence are still unclear.The purpose of this project is to analyze the clinicopathological characteristics ofDTC in children and adolescents,and to explore relevant factors that can predict the risk of recurrence after surgery,for guiding the clinical practice.ObjectiveTo analyze the unique biological characteristics of DTC in children and adolescents and the differences in clinicopathological characteristics among different age groups,and to explore the specific related factors influencing the prognosis of DTC in children and adolescents.MethodsThe clinic-pathologic data of 156 children and adolescents suffering from DTC admitted to our Hospital from August 2009 to June 2019 were collected.The inclusion criteria:(1)The age of first diagnosis was no more than 18 years old;(2)The first diagnosis was in this hospital and the DTC was confirmed by virtue of routine pathologic diagnosis after operative treatment;(3)Complete clinic-pathologic data and follow-up information.The clinic-pathological characteristics of different age groups in children and adolescents with DTC were compared and analyzed.On this basis,such statistical approaches as Kaplan–Meier survival analysis and COX proportional hazard model were employed to probe into the correlativity between clinic-pathologic indexes and prognosis.Relevant factors which may have impacts on disease-free survival were also investigated.ResultsThe date of the last follow-up was June 30,2019.The follow-up duration was6?84 months.The median follow-up duration was 28 months.4 cases were lost during the follow-up,which accounted for 2.6%.For these children and adolescent suffering from DTC,the disease-free survival rate of 3 years and 5 years accounted for 79.7% and 76.8%,respectively.Compared with the adolescent group with DTC,the child group was more likely to show multiple lesions(P=0.014)and lymphatic metastasis(P=0.038).Such a disparity is of significance in statistics.The result of single-factor analysis indicates: the factor possessing impacts on the postoperative recurrence includes the age(P=0.018),number of lesions(P<0.001),size of tumor(P=0.002),lymphatic metastasis in lateral neck(P<0.001),whether there was lung metastases when definite diagnosis was made(P=0.02)and extra-thyroidal extension(P=0.005).The result of COX multi-factor regression reveals: multiple lesions(HR:3.234,95%CI is 1.222?8.559,P=0.018)and latera lymph node metastasis(HR:4.070,95%CI is 1.075?15.417,P=0.039)are independent factors that affect the postoperative recurrence of children and adolescents with DTC.Conclusion1.Children and adolescents suffering from DTC witness higher incidence in cervical lymph node metastasis,extra-thyroidal extension and distant metastasis,but with favorable overall prognosis.2.Children with DTC under 14 years of age were more likely to have multiple lesions and cervical lymph node metastasis than adolescents with DTC.3.Multiple lesions and lateral lymph node metastasis are the independent factor affecting the postoperative recurrence of children and adolescents with DTC.