Analysis Of Clinical Characteristics And Risk Factors For Postoperative Recurrence In Pediatric And Adolescent Patients With Differentiated Thyroid Cancer

Objective: To explore the clinical characteristics of children and adolescents with differentiated thyroid cancer,and to explore the risk factors for postoperative recurrence of children and adolescents with differentiated thyroid cancer.Methods: The clinical and follow-up data of 103 children and adolescents with DTC admitted to the Department of Head and Neck Surgery of Yunnan Cancer Hospital from 2002 to 2021 were retrospectively analyzed.Inclusion criteria: 1.Thyroid surgery was performed in our hospital at first diagnosis;2.Age ≤20 years old;3.The postoperative pathological classification was differentiated thyroid carcinoma,which was treated with TSH inhibition.Exclusion criteria: 1.Complicated with other primary malignant tumors;2.Incomplete clinical and follow-up data;The clinical data of children and adolescents with DTC meeting the criteria were analyzed statistically.According to the United Nations General Assembly’s definition of youth in 2010 and the broad consensus of the medical community,those ≤14 years old are defined as children’s group,those > 14 years old and those < 20 years old are defined as adolescents.Chi-square test and Fisher’s exact probability method were used to compare the clinicopathologic features of children and adolescents with DTC.The clinicopathologic features of 40 children and adolescents with DTC and 40 adults with DTC were compared by random sampling method.Firstly,univariate analysis was used to analyze the risk factors of postoperative recurrence of thyroid cancer in children and adolescents,and COX regression model was used for multivariate analysis.P < 0.05 was considered statistically significant.Results: A total of 103 eligible patients were included in the whole group,and the last follow-up was from 13 to 122 months until August 2022.There were 35 males and 68 females,with an average age of 17.42 years.Preoperative routine ultrasound examination of thyroid and cervical lymph nodes in 103 children and adolescents with DTC showed thyroid space occupying lesions or cervical lymph node enlargement.The classification of thyroid Ultrasound Imaging Report and Data System(TI-RADS)suggested that the proportion of TI-RADS 4 or above was 97.18%(100/103).The 92 cases underwent cervical enhanced CT examination before surgery,and the CT results showed that 32 cases showed suspicious lymph nodes,26 cases showed lymph node enlargement with metastasis,14 cases showed distant metastasis(both lungs),and 44 cases had no obvious metastatic lymph nodes.All 103 patients received surgical treatment and postoperative TSH inhibition.Compared with the adolescent group,the children group was more likely to have multiple lesions(x2=5.895,P=0.012),positive lymph node metastasis in the central region(x 2 =4.825,P=0.028),positive lymph node metastasis in the cervical region(x2=24.856,P=0.015),and late N stage(x2=3.716,P=0.045).Compared with adult DTC patients,visits for painless neck masses were more common in children and adolescents(x2=11.429,P=0.001),neck LNM(x2=18.061,P < 0.001)and primary lesion diameter greater than 20mm(x2=20.460,P< 0.001).The difference was statistically significant.Univariate analysis of postoperative recurrence of DTC in children and adolescents showed ETE(x2=40.307,P < 0.001),lateral cervical lymph node metastasis(LNM)(x 2 =10.715,p=0.001),number of lesions(x2=4.021,P=0.045),location of primary lesion(x2=19.251,P <0.001),no lung metastasis at diagnosis(x 2 =52.018,P< 0.001),radioiodine-131treatment(x2=33.383,P < 0.001),clinical staging of TNM/AJCC(x2=40.291,P <0.001),total thyroidectomy(TT)(x2=33.584,P < 0.001),ATA risk stratification(x2=18.160,P < 0.001)were associated with postoperative recurrence,and the difference was statistically significant.Multivariate analysis suggested that ATA risk stratification(HR=12.207,95%CI=2.595-25.674,P < 0.001)and LNM(HR=7.241,95%CI=0.974-53.850,P=0.047)were independent risk factors for postoperative recurrence of DTC in children and adolescents.The difference was statistically significant.Conclusion: Compared with adolescent DTC patients,pediatric DTC patients were more likely to have central LNM,lateral cervical LNM,multiple lesions,bilateral primary lesions,and later TNM/AJCC N staging.Compared with adult DTC patients,pediatric and adolescent DTC patients were more likely to have painless neck masses,cervical LNM,and larger tumor diameter.Cervical lymph node metastasis and ATA medium and high risk stratification are independent risk factors for postoperative recurrence of DTC in children and adolescents.