Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China.
Front Endocrinol (Lausanne). 2021 Nov 11;12:760901. doi: 10.3389/fendo.2021.760901. eCollection 2021.
Children with papillary thyroid cancer (PTC) have a higher invasive rate and distant metastasis rate, but the mortality rate is lower with unknown reasons. The majority of PTC cases comprise classical papillary thyroid carcinoma (CPTC) and follicular variant papillary thyroid carcinoma (FVPTC). This study aimed to determine the relationship between histopathological subtype and rate of distant metastasis and investigate factors influencing distant metastasis in pediatric PTC.
A total of 102,981 PTC patients were recruited from SEER registry, 2004-2015. Proportion of distant metastasis between children (≤18 years) and adults with different histopathological subtypes was compared by propensity score matching. The cut-off age for distant metastasis in children was calculated by receiver operating characteristic (ROC) curve, and the risk factors for distant metastasis in pediatric patients were analyzed by logistic regression models.
Among the 1,484 children and 101,497 adults included in the study, the incidence of CPTC patients with distant metastasis in children was higher than that in adults (<0.001). The ROC curve was calculated, which yielded a cut-off age for distant metastasis in CPTC children as 16 years old. In CPTC, the proportion of young children (2-16 years) with distant metastasis was higher than that of adolescents (17-18 years) and adults (>18 years) (both <0.001). While there was no such trend in FVPTC. In young children (2-16 years), the incidence of CPTC with distant metastasis was higher than FVPTC (=0.006). There was no difference between the proportion of CPTC and FVPTC with distant metastasis in adolescents (17-18 years) and adults. Logistic regression models revealed that extrathyroidal extension, lymph node metastasis and CPTC histopathological subtype were risk factors for distant metastasis in young children aged 2 -16 years.
In CPTC, the incidence of distant metastasis in young children (2-16 years) was significantly higher than that in adolescents (17-18 years) and adults (>18 years). In patients with distant metastasis aged 2-16 years, the proportion of CPTC was higer than that of FVPTC. Extrathyroidal extension, lymph node metastasis, and CPTC histopathological subtype were risk factors for distant metastasis in young children aged 2-16 years.
儿童甲状腺乳头状癌（PTC）具有较高的侵袭性和远处转移率，但死亡率较低，原因不明。大多数 PTC 病例包括经典型甲状腺乳头状癌（CPTC）和滤泡状变异型甲状腺乳头状癌（FVPTC）。本研究旨在确定组织病理学亚型与远处转移率之间的关系，并探讨影响儿童 PTC 远处转移的因素。
本研究共纳入 2004 年至 2015 年 SEER 注册中心的 102981 例 PTC 患者。通过倾向评分匹配比较儿童（≤18 岁）和成人不同组织病理学亚型之间远处转移的比例。通过受试者工作特征（ROC）曲线计算儿童远处转移的截断年龄，并通过逻辑回归模型分析儿童患者远处转移的危险因素。
在纳入的 1484 名儿童和 101497 名成人中，CPTC 患儿远处转移患者的发生率高于成人（<0.001）。计算 ROC 曲线，得出 CPTC 患儿远处转移的截断年龄为 16 岁。在 CPTC 中，2-16 岁的年幼儿童（2-16 岁）远处转移的比例高于青少年（17-18 岁）和成人（>18 岁）（均<0.001）。而在 FVPTC 中则没有这种趋势。在年幼儿童（2-16 岁）中，CPTC 远处转移的发生率高于 FVPTC（=0.006）。在青少年（17-18 岁）和成人中，CPTC 和 FVPTC 远处转移的比例没有差异。Logistic 回归模型显示，甲状腺外侵犯、淋巴结转移和 CPTC 组织病理学亚型是 2-16 岁儿童远处转移的危险因素。
在 CPTC 中，2-16 岁的年幼儿童（2-16 岁）远处转移的发生率明显高于青少年（17-18 岁）和成人（>18 岁）。在 2-16 岁发生远处转移的患者中，CPTC 的比例高于 FVPTC。甲状腺外侵犯、淋巴结转移和 CPTC 组织病理学亚型是 2-16 岁儿童远处转移的危险因素。
