Predictive Factors for Recurrence from a Series of 74 Children and Adolescents with Differentiated Thyroid Cancer

Abstract

The influence of clinical and treatment factors on the risk of recurrence was analyzed from a retrospective series of 74 children and adolescents with thyroid cancer (55 girls, 19 boys; age 2-20 years). Two groups, comparable in terms of age, sex, and previous radiotherapy, were compared according to the presence (group 1) or absence (group 2) of cervical lymph nodes identified by palpation or ultrasonography. Total thyroidectomy (TT) with lymph node dissection (LND) was performed in the 19 group 1 patients, whereas in group 2 patients (n = 55) lobectomy was performed in 29, TT in 26, and LND in 7. Pathology studies showed papillary thyroid carcinoma in 95% of cases. In group 1, tumors were more frequently multifocal (89% vs. 16% in group 2), invasive with extension beyond the thyroid capsule (68% vs. 5% in group 2), and of the diffuse sclerosing variety (63% vs. 4% in group 2) (p < 0.001). With a median follow-up of 61 months, lymph node recurrence was seen in 53% of group 1 patients and in no patients in group 2. Three group 2 patients (10%) were reoperated for a local recurrence after lobectomy. Risk factors for reintervention were young age (< 15 years) (p < 0.01) and cervical lymph nodes (p < 0.001). Survivals without reintervention at 5 and 10 years were, respectively, 58% and 38% for group 1 and 94% and 90% for group 2 (p < 0.001). At the time of analysis, 68% of group 1 patients and 98% of group 2 patients were in remission. In conclusion, the presence of palpable cervical lymph nodes at diagnosis is associated with more invasive forms of malignancy and is a predictive factor of recurrence regardless of the extent of the initial surgery.

Recurrent Disease in Juvenile Differentiated Thyroid Carcinoma: Prognostic Factors, Treatments, and Outcomes

“…However, there was no correlation between lymph node metastases at presentation and risk of recurrence. This finding is consistent with 1 previous report (22) but not with others (28,30,32). Some authors have reported a lower or higher incidence of initial lymph node involvement, ranging from 40% to 80% (5,12,17,18,20,22,32,33).…”

“…Popovtzer et al (18) concluded that TTx led to a significantly lower recurrence rate (7.5%) than hemithyroidectomy (38%) (P , 0.005). Nevertheless, some authors have reported no relationship between the extent of surgery and the recurrence rate (9,24,30).…”

Thyroid cancer: is the incidence rise abating?

“…In the present series, the overall proportion of aggressive microcancers with ET growth or LNM was lower than that reported in other studies (23,24). Lymph node dissection was systematically performed when potentially metastatic lymph nodes were found before or during surgery, but prophylactic dissection of the central compartment was not the rule in the case of small tumors without clinical or ultrasonographic evidence of lymph node involvement (25). This attitude probably leads to an underestimation of microscopic LNM (26).…”

Pediatric Thyroid Cancers: An Indian Perspective

“…Some surgeons cite the excellent survival in these patients counterbalancing the morbidity of aggressive surgery, and hence recommend conservative surgery [35,36] Most surgeons prefer to perform a total thyroidectomy for pediatric DTCs [6,7,22,25,29,[37][38][39][40], and the arguments in favour of this are multifold: (a) Multifocal disease occurs in 40% of pediatric PTC, and has a greater risk for recurrence; (b) Pediatric DTC commonly has regional lymph node disease and a greater risk for distant metastasis; (c) Total thyroidectomy will facilitate the future use of radioactive iodine (RAI) where indicated; (d) Postoperative RAI scans and thyroglobulin assays can be best used after total thyroidectomy, these are especially useful in picking pulmonary metastases that may be undetected on initial X-ray. We found that an initial X-ray of chest picked only about 31% of pulmonary metastases [3].…”