medwireNews: Recurrence-free survival (RFS) is poorer in paediatric patients with multifocal papillary thyroid cancer (PTC) than in their adult counterparts, suggests a review of South Korean patients.
The study included medical records for 150 patients aged less than 20 years who were diagnosed between 1980 and 2013 at Seoul National University, 124 of whom were followed up for at least 12 months after surgery.
Patients became significantly more likely to be diagnosed with a small tumour over time, from 9.0% before 2010 to 36.8% in later years, report Young Joo Park, from Seoul National University College of Medicine and co-workers.
By contrast, other characteristics, such as the predominance of female patients, or the proportion of patients with multifocality, extrathyroidal extension or metastases to the lymph nodes and lungs, were stable over the study period.
The 5- and 10-year rates of recurrence in the patients were 14.5% and 34.4%, respectively, and did not significantly decrease over the study duration.
When data for 3071 adult patients treated for PTC over a similar era were combined with the paediatric records, all-ages analysis showed that younger age was significantly associated with increased rates of extrathyroid extension and both lymph node and lung metastasis.
RFS was significantly shorter in paediatric patients than in adults aged 20 to 54 years of age and comparable with those aged 55 years or older. But young age was not a significant independent predictor for RFS after adjusting for gender and pathological characteristics and the paediatric patients’ prognosis was not poorer than expected considering their advanced stage disease at presentation.
Park found that RFS was significantly predicted by multifocality and tumour size in paediatric patients, but by extrathyroidal extension and lymph node metastasis in the all-ages analysis. “Thus, the prognostic implications of the various pathological characteristics differ between pediatric and adult patients”, they say.
“[B]ecause previous data on patients with pediatric thyroid cancer are relatively limited, the large sample size of this cohort and its long-term follow-up are noteworthy”, the researchers report in The Journal of Clinical Endocrinology & Metabolism.
“Furthermore, this study was strengthened by its suggestions of predictors of long-term outcomes in pediatric patients with PTC compared to adult patients with PTC; such information provides the clinician with practical implications such that pediatric patients with multifocal PTC should be carefully managed and followed up.”
They conclude: “This study will contribute to and facilitate construction of a pediatric-specific staging system in the future.”
By Lynda Williams, Senior medwireNews Reporter
J Clin Endocrinol Metab 2015; Advance online publication
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