Prepubertal Children with Papillary Thyroid Carcinoma Present with More Invasive Disease than Adolescents and Young Adults.

Overview

abstract

INTRODUCTION: Pediatric papillary thyroid carcinomas (PTC) 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. METHODS: The National Cancer Database was interrogated for pediatric and young adult PTCs diagnosed between 2004 and 2017. Clinical variables were compared between prepubertal (≤10yo), adolescent (11-18yo), and young adult (19-39yo) groups. Multivariable logistic regression modeling for independent predictors of metastases was conducted. A sub-analysis of microcarcinomas (size≤10mm) was performed. RESULTS: 4,860 pediatric (prepubertal n=274, adolescents n=4,586) 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 (LVI), and extrathyroidal extension (ETE). Prepubertal age was an independent predictor of positive regional nodes (AOR 1.36, 95%-CI [1.01-1.84], p=0.04) and distant metastatic disease (AOR 3.12, 95%-CI [1.96-4.96], p<0.001). However, there was no difference in survival between groups (p=0.32). Prepubertal age independently predicted lymph node metastases for microcarcinomas (AOR 2.19, 95%-CI [1.10-4.36], p=0.03). Prepubertal (n=41) versus adolescent (n=937) patient age was associated with gross ETE (p=0.004), even with primary tumors ≤1cm in size. CONCLUSIONS: Patients aged less than eleven years old present with more advanced disease than adolescents, with a higher likelihood of nodal and distant metastatic disease at time of diagnosis, though survival is high. Prepubertal children undergo more extensive treatment, likely reflective of more invasive disease at the outset, even in the setting of a sub centimeter primary tumor.