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Martucci C, Crocoli A, De Pasquale MD, Spinelli C, Strambi S, Brazzarola P, Morelli E, Cassiani J, Mancera J, Luengas JP, Lobos P, Liberto D, Astori E, Sarnacki S, Couloigner V, Simon F, Lambert C, Abib SDCV, Cervantes O, Caran E, Delgado Lindman D, Jones MO, Shukla R, Losty PD, Inserra A. Thyroid cancer in children: A multicenter international study highlighting clinical features and surgical outcomes of primary and secondary tumors. Front Pediatr 2022; 10:914942. [PMID: 35935364 PMCID: PMC9354958 DOI: 10.3389/fped.2022.914942] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Thyroid gland malignancies are rare in pediatric patients (0.7% of tumors); only 1.8% are observed in patients aged <20 years, with a higher prevalence recorded in women and adolescents. Risk factors include genetic syndromes, MEN disorders, autoimmune diseases, and exposure to ionizing radiation. Radiotherapy is also associated with an increased risk of secondary thyroid cancer. This study describes the clinical features and surgical outcomes of primary and secondary thyroid tumors in pediatric patients. METHODS Institutional data were collected from eight international surgical oncology centers for pediatric patients with thyroid cancer between 2000 and 2020. Statistical analyses were performed using the GraphPad Prism software. RESULTS Among 255 total cases of thyroid cancer, only 13 (5.1%) were secondary tumors. Primary thyroid malignancies were more likely to be multifocal in origin (odds ratio [OR] 1.993, 95% confidence interval [CI].7466-5.132, p = 0.2323), have bilateral glandular location (OR 2.847, 95% CI.6835-12.68, p = 0.2648), and be metastatic at first diagnosis (OR 1.259, 95% CI.3267-5.696, p > 0.999). Secondary tumors showed a higher incidence of disease relapse (OR 1.556, 95% CI.4579-5.57, p = 0.4525) and surgical complications (OR 2.042, 95% CI 0.7917-5.221, p = 0.1614), including hypoparathyroidism and recurrent laryngeal nerve injury. The overall survival (OS) was 99% at 1 year and 97% after 10 years. No EFS differences were evident between the primary and secondary tumors (chi-square 0.7307, p = 0.39026). CONCLUSIONS This multicenter study demonstrated excellent survival in pediatric thyroid malignancies. Secondary tumors exhibited greater disease relapse (15.8 vs. 10.5%) and a higher incidence of surgical complications (36.8 vs. 22.2%).
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Affiliation(s)
- Cristina Martucci
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Crocoli
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Debora De Pasquale
- Department of Pediatric Hematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Claudio Spinelli
- Department of Pediatric Surgery, University of Pisa, Pisa, Italy
| | - Silvia Strambi
- Department of Pediatric Surgery, University of Pisa, Pisa, Italy
| | - Paolo Brazzarola
- Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Eleonora Morelli
- Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Jessica Cassiani
- Department of Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Juliana Mancera
- Department of Pediatric Surgery, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Juan Pablo Luengas
- Department of Pediatric Oncology, National Cancer Institute, Liverpool, Colombia
| | - Pablo Lobos
- Department of Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Liberto
- Department of Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Estefanìa Astori
- Department of Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Necker-Enfants Malades Hospital, Université de Paris, Paris, France
| | - Vincent Couloigner
- Department of Pediatric Otolaryngology, Necker-Enfants Malades Hospital, Université de Paris, Paris, France
| | - François Simon
- Department of Pediatric Otolaryngology, Necker-Enfants Malades Hospital, Université de Paris, Paris, France
| | - Cassandre Lambert
- Department of Pediatric Otolaryngology, Necker-Enfants Malades Hospital, Université de Paris, Paris, France
| | - Simone de Campos Vieira Abib
- Department of Pediatric Oncology Surgery and Pediatric Oncology, Pediatric Oncology Institute-GRACC, Federal University of São Paulo, São Paulo, Brazil
| | - Onivaldo Cervantes
- Department of Head and Neck Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Eliana Caran
- Department of Pediatric Oncology Surgery and Pediatric Oncology, Pediatric Oncology Institute-GRACC, Federal University of São Paulo, São Paulo, Brazil
| | - Diana Delgado Lindman
- Department of Pediatric Oncology Surgery and Pediatric Oncology, Pediatric Oncology Institute-GRACC, Federal University of São Paulo, São Paulo, Brazil
| | - Matthew O Jones
- Department of Pediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Rajeev Shukla
- Department of Pathology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Paul D Losty
- Department of Pediatric Surgery, Faculty of Health and Life Sciences, Alder Hey Children's Hospital NHS Foundation Trust, University of Liverpool, Liverpool, United Kingdom
| | - Alessandro Inserra
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Development and validation of a population-based model for predicting the regional lymph node metastasis in adolescent differentiated thyroid carcinoma. Oral Oncol 2021; 121:105507. [PMID: 34450454 DOI: 10.1016/j.oraloncology.2021.105507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adolescent differentiated thyroid carcinoma (DTC) is a rare type of thyroid cancer that represents a special entity of all endocrine-related cancer. This study aims to establish the first nomogram for predicting the regional (central and lateral) lymph node metastasis (LNM) in the adolescent population for better surgical management. METHOD We retrospectively reviewed the clinicopathology characteristics of adolescent patients with DTC in the Surveillance, Epidemiology, and End Results database between 2010 and 2015. RESULTS A total of 1,930 adolescent patients between the ages of 10 and 24 years from the SEER database were enrolled in this study. Six predictive factors including age, race, histology, multifocality, extrathyroidal invasion (EI) and tumor size were identified to be significantly associated with the regional LNM via univariate and multivariate logistic regression analyses. These indicators were used to construct a nomogram for predicting the regional LNM in adolescent patients with DTC. Moreover, a satisfied predictive ability of the model was determined with a C-index of 0.794, supported by an internal validation group with a C-index of 0.776. The Decision Curve Analysis and calibration curve further conducted a great agreement in our model. CONCLUSION The first predictive model containing multiple factors has been successfully established with good discrimination for predicting the regional LNM in adolescent patients with DTC. This nomogram could effectively help surgeons to make better individualized surgical decision intraoperatively, especially in terms of whether cervical lymph node dissection (LND) is warranted.
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