Persons Emily M, Hussein Mohammad H, Herrera Marcela, Pinion Dylan, Webster Alyssa, Pineda Eric, Fawzy Manal S, Toraih Eman A, Kandil Emad
School of Medicine, Tulane University, New Orleans, LA 70112, USA.
Ochsner Clinic Foundation, New Orleans, LA 70112, USA.
Cancers (Basel). 2025 Jan 1;17(1):107. doi: 10.3390/cancers17010107.
BACKGROUND/OBJECTIVES: Pediatric populations with well-differentiated thyroid cancer typically have favorable prognoses. However, the role of radioactive iodine (RAI) ablation in these patients remains uncertain. This investigation evaluates the national trends, therapeutic practices, and the impact of RAI on clinical outcomes.
Patients aged 21 years or younger with differentiated thyroid cancer, identified from the SEER database between 2000 and 2019, were analyzed. We compared the treatment approaches and survival outcomes of patients who underwent RAI ablation with those who did not.
This retrospective cohort study encompassed 5318 pediatric patients, with 55.9% ( = 2973) who underwent RAI ablation. RAI utilization declined from 65% to 38.4% in 2019. Compared with those who did not undergo RAI, RAI patients presented with a larger tumor size (mean size: 27.7 vs. 20.4 mm), a higher T3/T4 stage (35.8% vs. 15.3%), nodal metastases (60.7% vs. 28.8%), and distant metastases (2.7% vs. 0.9%) (all < 0.001). Despite this, RAI was not an independent predictor of recurrence, second malignancy, or mortality. The analysis showed no significant differences in long-term survival between the RAI and non-RAI groups ( > 0.05), with African American patients having an increased risk of mortality (HR = 3.81; = 0.038). Cancer-directed surgery emerged as a protective factor (HR = 0.08; = 0.018), while RAI treatment did not significantly affect mortality risk ( = 0.09).
Excellent pediatric thyroid cancer outcomes were achieved regardless of RAI use. Further research should clarify appropriate RAI indications while addressing racial outcome inequities.
背景/目的：分化型甲状腺癌的儿科患者通常预后良好。然而，放射性碘（RAI）消融在这些患者中的作用仍不确定。本研究评估了全国范围内的趋势、治疗实践以及RAI对临床结局的影响。
分析了2000年至2019年间从监测、流行病学和最终结果（SEER）数据库中确定的21岁及以下的分化型甲状腺癌患者。我们比较了接受RAI消融的患者与未接受RAI消融的患者的治疗方法和生存结局。
这项回顾性队列研究纳入了5318名儿科患者，其中55.9%（n = 2973）接受了RAI消融。2019年，RAI的使用率从65%降至38.4%。与未接受RAI的患者相比，接受RAI的患者肿瘤尺寸更大（平均尺寸：27.7对20.4毫米），T3/T4分期更高（35.8%对15.3%），有淋巴结转移（60.7%对28.8%）和远处转移（2.7%对0.9%）（所有P < 0.001）。尽管如此，RAI并不是复发、第二原发恶性肿瘤或死亡率的独立预测因素。分析显示，RAI组和非RAI组之间的长期生存没有显著差异（P > 0.05），非裔美国患者的死亡风险增加（风险比[HR] = 3.81；P = 0.038）。癌症导向手术是一个保护因素（HR = 0.08；P = 0.018），而RAI治疗对死亡风险没有显著影响（P = 0.09）。
无论是否使用RAI，儿科甲状腺癌都取得了良好的治疗效果。进一步的研究应明确合适的RAI适应症，同时解决种族间治疗结局的不平等问题。
