Thiesmeyer Jessica W, Egan Caitlin E, Greenberg Jacques A, Beninato Toni, Zarnegar Rasa, Fahey Iii Thomas J, Finnerty Brendan M
Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA.
Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Thyroid. 2023 Feb;33(2):214-222. doi: 10.1089/thy.2022.0098. Epub 2022 Dec 9.
Pediatric papillary thyroid carcinomas (PTCs) are more invasive than adult PTCs. No large, contemporary cohort study has been conducted to determine whether younger children are at higher risk for advanced disease at presentation compared to adolescents. We aimed to describe pediatric PTC and contextualize its characteristics with a young adult comparison cohort. The National Cancer Database was interrogated for pediatric and young adult PTCs diagnosed between 2004 and 2017. Clinical variables were compared between prepubertal (≤10 years old), adolescent (11-18 years old), and young adult (19-39 years old) groups. Multivariable logistic regression modeling for independent predictors of metastases was conducted. A subanalysis of microcarcinomas (size ≤10 mm) was performed. A total of 4860 pediatric (prepubertal = 274, adolescents = 4586) and 101,159 young adult patients were included. Prepubertal patients presented with more extensive burden of disease, including significantly larger primary tumors, higher prevalence of nodal and distant metastases, and increased frequency of features such as lymphovascular invasion, and extrathyroidal extension (ETE). Prepubertal age was an independent predictor of positive regional nodes (adjusted odds ratio [AOR] = 1.36 [95% confidence interval {CI} 1.01-1.84], = 0.04) and distant metastatic disease (AOR = 3.12 [CI 1.96-4.96], < 0.001). However, there was no difference in survival between groups ( = 0.32). Prepubertal age independently predicted lymph node metastases for microcarcinomas (AOR = 2.19 [CI 1.10-4.36], = 0.03). Prepubertal ( = 41) versus adolescent ( = 937) patient age was associated with gross ETE ( = 0.004), even with primary tumors ≤1 cm in size. Patients aged <11 years old present with more advanced disease than adolescents, with a higher likelihood of nodal and distant metastatic disease at time of diagnosis, although survival is high. Prepubertal children undergo more extensive treatment, likely reflective of more invasive disease at the outset, even in the setting of a subcentimeter primary tumor.
儿童乳头状甲状腺癌（PTC）比成人PTC更具侵袭性。尚未进行大规模的当代队列研究来确定年幼儿童与青少年相比，在就诊时患晚期疾病的风险是否更高。我们旨在描述儿童PTC，并将其特征与年轻成人比较队列进行对比分析。我们查询了国家癌症数据库中2004年至2017年间诊断的儿童和年轻成人PTC病例。比较了青春期前（≤10岁）、青少年（11 - 18岁）和年轻成人（19 - 39岁）组之间的临床变量。对转移的独立预测因素进行了多变量逻辑回归建模。对微癌（大小≤10毫米）进行了亚组分析。共纳入4860例儿童患者（青春期前 = 274例，青少年 = 4586例）和101,159例年轻成人患者。青春期前患者的疾病负担更重，包括原发肿瘤明显更大、淋巴结和远处转移的患病率更高，以及诸如脉管侵犯和甲状腺外侵犯（ETE）等特征的频率增加。青春期前年龄是区域淋巴结阳性（调整后的优势比[AOR] = 1.36 [95%置信区间{CI} 1.01 - 1.84]，P = 0.04）和远处转移性疾病（AOR = 3.12 [CI 1.96 - 4.96]，P < 0.001）的独立预测因素。然而，各组之间的生存率没有差异（P = 0.32）。青春期前年龄独立预测微癌的淋巴结转移（AOR = 2.19 [CI 1.10 - 4.36]，P = 0.03）。青春期前（n = 41）与青少年（n = 937）患者年龄与肉眼可见的ETE相关（P = 0.004），即使原发肿瘤大小≤1厘米。年龄<11岁的患者比青少年表现出更晚期的疾病，在诊断时发生淋巴结和远处转移性疾病的可能性更高，尽管生存率较高。青春期前儿童接受更广泛的治疗，这可能反映出即使在原发肿瘤小于1厘米的情况下，疾病从一开始就更具侵袭性。
