Clinicopathological characteristics and prognosis of papillary thyroid cancer in adolescents_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SUN Yuxiao ¹ , LIU Weihao ¹ , ZHANG Yifei ¹ , LI Hongqiang ¹ , TANG Yifeng ¹ ,  YIN Detao ^1,2,3

1. Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, P. R. China;
2. Engineering Research Center of Multidisciplinary Diagnosis and Treatment of Thyroid Cancer of Henan Province, Zhengzhou 450052, P. R. China;
3. Key Medicine Laboratory of Thyroid Cancer of Henan Province, Zhengzhou 450052, P. R. China;

Corresponding?author：

YIN Detao, Email: detaoyin@zzu.edu.cn

Keywords：

papillary thyroid cancer; adolescent; lateral lymph node metastasis; recurrence

DOI：

10.7507/1007-9424.202403033

Video：

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Objective To summarize the clinicopathological characteristics of papillary thyroid cancer (PTC) in adolescents and analyze the risk factors affecting lateral lymph node metastasis and prognosis. Methods In retrospectively, 150 adolescent PTC patients admitted to the Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University from January 2012 to January 2022 and meeting the inclusion and exclusion criterias were collected as the study subjects (adolescent group), and 100 adult PTC patients were selected as adult group. Statistical analysis was performed with SPSS 25.0 software to compare the clinicopathological characteristics of the patients in the two groups, and to explore the risk factors for lateral lymph node metastasis and recurrence in adolescent PTC patients by using logistic regression and Cox proportional hazards regression models, respectively. Results Adolescents with PTC were more prone to extrandular invasion [30.0% (45/150) versus 17.0% (17/100), P=0.020], neck lymph node metastasis [79.3% (119/150) versus 48.0% (48/100), P<0.001], central lymph node metastasis [78.7% (118/150) versus 48.0% (48/100), P<0.001], lateral lymph node metastasis [44.0% (66/150) versus 12.0% (12/100), P<0.001]; and had a greater maximum tumor diameter (1.75 cm versus 0.75 cm, P＜0.001) and higher ratio of greater maximum tumor diameter ＞2 cm [45.3% (68/150) versus 8.0% (8/100), P＜0.001] in adolescent PTC patients. In adolescent PTC patients, extraglandular invasion (OR=2.654, P=0.022), multifoci (OR=4.860, P<0.001) and maximum tumor diameter>2 cm (OR=3.845, P=0.001) were risk factors for lateral lymph node metastasis; lateral lymph node metastasis (RR=10.105, P=0.040) and distant metastasis (RR=7.058, P=0.003) were predictors of postoperative recurrence in adolescent PTC patients. Conclusions Compared with adult PTC patients, adolescent PTC patients have more aggressive tumors. Adolescent PTC with extraglandular invasion, multilesions, and maximum tumor diameter>2 cm should be considered for lateral lymph node dissection; and adolescent PTC patients with lateral lymph node metastasis and distant metastasis should pay close attention to their recurrence status.

Citation： SUN Yuxiao, LIU Weihao, ZHANG Yifei, LI Hongqiang, TANG Yifeng, YIN Detao. Clinicopathological characteristics and prognosis of papillary thyroid cancer in adolescents. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(11): 1330-1335. doi: 10.7507/1007-9424.202403033 Copy

1.	常靖濤, 王崴然, 賈寶凇, 等. cN0多灶甲狀腺微小乳頭狀癌與中央區淋巴結轉移關系的研究進展. 中國普外基礎與臨床雜志, 2022, 29(3): 382-388.
2.	王志宏, 張浩. 兒童及青少年分化型甲狀腺癌外科治療策略. 中國實用外科雜志, 2022, 42(6): 648-652.
3.	Management Guidelines for children with thyroid nodules and differentiated thyroid cancer. Pediatrics, 2018, 142(6): e20183063. doi: 10.1542/peds.2018-3063.
4.	張桂萍, 詹維偉. 兒童及青少年甲狀腺癌超聲診斷. 中國實用外科雜志, 2022, 42(6): 643-648.
5.	田文, 萬政. 重視兒童及青少年甲狀腺癌的規范化診治. 中國實用外科雜志, 2022, 42(6): 621-624, 666.
6.	de Jong MC, Gaze MN, Szychot E, et al. Treating papillary and follicular thyroid cancer in children and young people: single UK-center experience between 2003 and 2018. J Pediatr Surg, 2021, 56(3): 534-539.
7.	楊崚怡, 郭凱, 錢凱, 等. 兒童及青少年甲狀腺癌分子生物學研究進展. 中國實用外科雜志, 2022, 42(6): 716-720.
8.	倪鑫, 王生才, 劉雨薇. 《兒童甲狀腺癌診療規范 (2021年版)》解讀. 中國實用外科雜志, 2022, 42(6): 625-628.
9.	中國臨床腫瘤學會核醫學專家委員會, 中國臨床腫瘤學會甲狀腺癌專家委員會, 中國醫療保健國際交流促進會甲狀腺疾病專業委員會, 等. 兒童及青少年分化型甲狀腺癌核醫學診治中國專家共識 (2022年版). 中國癌癥雜志, 2022, 32(5): 451-468.
10.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
11.	陳怡如, 雷亞麗, 鄒聯洪, 等. 兒童及青少年甲狀腺癌的臨床特征與預后分析. 中國普通外科雜志, 2022, 31(5): 608-618.
12.	高洪波, 馬淋淋, 邰雋, 等. 兒童及青少年分化型甲狀腺癌的臨床病理特征分析. 中國耳鼻咽喉頭頸外科, 2016, 23(7): 371-373.
13.	Alzahrani AS, Alkhafaji D, Tuli M, et al. Comparison of differentiated thyroid cancer in children and adolescents (≤20 years) with young adults. Clin Endocrinol (Oxf), 2016, 84(4): 571-577.
14.	Lebbink CA, Links TP, Czarniecka A, et al. 2022 European Thyroid Association Guidelines for the management of pediatric thyroid nodules and differentiated thyroid carcinoma. Eur Thyroid J, 2022, 11(6): e220146.
15.	Lazar L, Lebenthal Y, Steinmetz A, et al. Differentiated thyroid carcinoma in pediatric patients: comparison of presentation and course between pre-pubertal children and adolescents. J Pediatr, 2009, 154(5): 708-714.
16.	Guo K, Qian K, Shi Y, et al. Clinical and molecular characterizations of papillary thyroid cancer in children and young adults: a multicenter retrospective study. Thyroid, 2021, 31(11): 1693-1706.
17.	Olmsted C, Arunachalam R, Gao X, et al. Pediatric differentiated thyroid carcinoma: trends in practice and outcomes over 40 years at a single tertiary care institution. J Pediatr Endocrinol Metab, 2017, 30(10): 1067-1074.
18.	趙文新, 王波, 翁煜景, 等. 兒童及青少年甲狀腺癌淋巴結轉移特點及治療策略. 中國實用外科雜志, 2017, 37(9): 973-977, 997.
19.	Russo M, Malandrino P, Moleti M, et al. Differentiated thyroid cancer in children: heterogeneity of predictive risk factors. Pediatr Blood Cancer, 2018, 65(9): e27226. doi: 10.1002/pbc.27226.
20.	Ito Y, Fukushima M, Higashiyama T, et al. Tumor size is the strongest predictor of microscopic lymph node metastasis and lymph node recurrence of N0 papillary thyroid carcinoma. Endocr J, 2013, 60(1): 113-117.
21.	毛曉春, 葉柳青, 項洋鋒, 等. 兒童及青少年甲狀腺乳頭狀癌頸側區淋巴結轉移風險預測模型研究. 中國耳鼻咽喉頭頸外科, 2022, 29(5): 278-282.
22.	Liang W, Sheng L, Zhou L, et al. Risk factors and prediction model for lateral lymph node metastasis of papillary thyroid carcinoma in children and adolescents. Cancer Manag Res, 2021, 13: 1551-1558.
23.	Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
24.	田文, 李晨, 姚京. 關于甲狀腺癌術后復發幾點思考. 中國實用外科雜志, 2021, 41(8): 849-852.
25.	Zanella AB, Scheffel RS, Weinert L, et al. New insights into the management of differentiated thyroid carcinoma in children and adolescents (review). Int J Oncol, 2021, 58(5): 13. doi: 10.3892/ijo.2021.5193.
26.	Klein Hesselink MS, Nies M, Bocca G, et al. Pediatric differentiated thyroid carcinoma in the Netherlands: a nationwide follow-up study. J Clin Endocrinol Metab, 2016, 101(5): 2031-2039.

1. 常靖濤, 王崴然, 賈寶凇, 等. cN0多灶甲狀腺微小乳頭狀癌與中央區淋巴結轉移關系的研究進展. 中國普外基礎與臨床雜志, 2022, 29(3): 382-388.
2. 王志宏, 張浩. 兒童及青少年分化型甲狀腺癌外科治療策略. 中國實用外科雜志, 2022, 42(6): 648-652.
3. Management Guidelines for children with thyroid nodules and differentiated thyroid cancer. Pediatrics, 2018, 142(6): e20183063. doi: 10.1542/peds.2018-3063.
4. 張桂萍, 詹維偉. 兒童及青少年甲狀腺癌超聲診斷. 中國實用外科雜志, 2022, 42(6): 643-648.
5. 田文, 萬政. 重視兒童及青少年甲狀腺癌的規范化診治. 中國實用外科雜志, 2022, 42(6): 621-624, 666.
6. de Jong MC, Gaze MN, Szychot E, et al. Treating papillary and follicular thyroid cancer in children and young people: single UK-center experience between 2003 and 2018. J Pediatr Surg, 2021, 56(3): 534-539.
7. 楊崚怡, 郭凱, 錢凱, 等. 兒童及青少年甲狀腺癌分子生物學研究進展. 中國實用外科雜志, 2022, 42(6): 716-720.
8. 倪鑫, 王生才, 劉雨薇. 《兒童甲狀腺癌診療規范 (2021年版)》解讀. 中國實用外科雜志, 2022, 42(6): 625-628.
9. 中國臨床腫瘤學會核醫學專家委員會, 中國臨床腫瘤學會甲狀腺癌專家委員會, 中國醫療保健國際交流促進會甲狀腺疾病專業委員會, 等. 兒童及青少年分化型甲狀腺癌核醫學診治中國專家共識 (2022年版). 中國癌癥雜志, 2022, 32(5): 451-468.
10. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
11. 陳怡如, 雷亞麗, 鄒聯洪, 等. 兒童及青少年甲狀腺癌的臨床特征與預后分析. 中國普通外科雜志, 2022, 31(5): 608-618.
12. 高洪波, 馬淋淋, 邰雋, 等. 兒童及青少年分化型甲狀腺癌的臨床病理特征分析. 中國耳鼻咽喉頭頸外科, 2016, 23(7): 371-373.
13. Alzahrani AS, Alkhafaji D, Tuli M, et al. Comparison of differentiated thyroid cancer in children and adolescents (≤20 years) with young adults. Clin Endocrinol (Oxf), 2016, 84(4): 571-577.
14. Lebbink CA, Links TP, Czarniecka A, et al. 2022 European Thyroid Association Guidelines for the management of pediatric thyroid nodules and differentiated thyroid carcinoma. Eur Thyroid J, 2022, 11(6): e220146.
15. Lazar L, Lebenthal Y, Steinmetz A, et al. Differentiated thyroid carcinoma in pediatric patients: comparison of presentation and course between pre-pubertal children and adolescents. J Pediatr, 2009, 154(5): 708-714.
16. Guo K, Qian K, Shi Y, et al. Clinical and molecular characterizations of papillary thyroid cancer in children and young adults: a multicenter retrospective study. Thyroid, 2021, 31(11): 1693-1706.
17. Olmsted C, Arunachalam R, Gao X, et al. Pediatric differentiated thyroid carcinoma: trends in practice and outcomes over 40 years at a single tertiary care institution. J Pediatr Endocrinol Metab, 2017, 30(10): 1067-1074.
18. 趙文新, 王波, 翁煜景, 等. 兒童及青少年甲狀腺癌淋巴結轉移特點及治療策略. 中國實用外科雜志, 2017, 37(9): 973-977, 997.
19. Russo M, Malandrino P, Moleti M, et al. Differentiated thyroid cancer in children: heterogeneity of predictive risk factors. Pediatr Blood Cancer, 2018, 65(9): e27226. doi: 10.1002/pbc.27226.
20. Ito Y, Fukushima M, Higashiyama T, et al. Tumor size is the strongest predictor of microscopic lymph node metastasis and lymph node recurrence of N0 papillary thyroid carcinoma. Endocr J, 2013, 60(1): 113-117.
21. 毛曉春, 葉柳青, 項洋鋒, 等. 兒童及青少年甲狀腺乳頭狀癌頸側區淋巴結轉移風險預測模型研究. 中國耳鼻咽喉頭頸外科, 2022, 29(5): 278-282.
22. Liang W, Sheng L, Zhou L, et al. Risk factors and prediction model for lateral lymph node metastasis of papillary thyroid carcinoma in children and adolescents. Cancer Manag Res, 2021, 13: 1551-1558.
23. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
24. 田文, 李晨, 姚京. 關于甲狀腺癌術后復發幾點思考. 中國實用外科雜志, 2021, 41(8): 849-852.
25. Zanella AB, Scheffel RS, Weinert L, et al. New insights into the management of differentiated thyroid carcinoma in children and adolescents (review). Int J Oncol, 2021, 58(5): 13. doi: 10.3892/ijo.2021.5193.
26. Klein Hesselink MS, Nies M, Bocca G, et al. Pediatric differentiated thyroid carcinoma in the Netherlands: a nationwide follow-up study. J Clin Endocrinol Metab, 2016, 101(5): 2031-2039.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinicopathological characteristics and prognosis of papillary thyroid cancer in adolescents

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