Predictive factors for recurrence of differentiated thyroid cancer in patients under 21 years of age and a meta-analysis of the current literature

Abstract

The influence of predictors for recurrence in relation to recurrence-free survival was analyzed retrospectively in differentiated thyroid cancer (DTC) patients under 21 years of age who underwent primary surgical treatment and who had a pathological diagnosis of DTC between 1983 and 2012 at Fudan University Cancer Hospital. Recurrences were retrospectively analyzed using a Cox regression model for the hazard ratio (HR) according to the clinicopathological features. A meta-analysis was performed with respect to the potential predictors for recurrence from current related studies. In the present study, there were 146 young patients aged from 7 to 20 years, with a female/male ratio of 2.65/1. Female gender was the only factor significantly associated with recurrence according to univariate (HR = 2.812, P = 0.037) and multivariate (HR = 4.107, P = 0.024) Cox regression analyses. Meta-analyses revealed that multifocality (HR = 1.91, P < 0.05) and presentation at diagnosis (HR = 1.39, P < 0.05) were highly associated with recurrence in young DTC patients. However, female gender and other factors, such as age (≤10 vs. 11-20 years), PTC (PTC vs. FTC), extrathyroidal extension, lymph node metastasis, total thyroidectomy (total vs. less than total), radioiodine therapy, and radiation history, were not associated with recurrence in young DTC patients. In conclusion, multifocality and presentation at diagnosis are strong predictive factors of recurrence in relation to recurrence-free survival. We recommend studies with larger sample sizes and longer follow-up to verify the influence of predictors for disease recurrence in young patients.

Prognostic analysis of recurrence in children and adolescents with differentiated thyroid cancer

“…[ 8 ] In our study, the Kaplan-Meier curve showed that the probability of recurrence at 10 years was 28.6%, which is consistent with previous reports of approximately 20% to 47%. [ 7 , 9 – 12 ] The high risk of recurrence in pediatrics distinguishes pediatric DTC from its adult counterpart. One recent study examined DTC patients with a high risk of recurrence with a median age of 43 years and reported a recurrence rate at 10 years of 16.8%, [ 13 ] nearly half the value in the present study.…”

Clinicopathological Characteristics and Prognosis of Papillary Thyroid Carcinoma in Naturally Menopausal Women with Various Durations of Premenarche, Reproductive Periods, and Postmenopausal Stages

“…The incidence of tumor multifocality and intrathyroidal dissemination, which represented invasive behavior by a tumor and led to a worse prognosis and the need for more aggressive treatments than unilateral tumors [13], was increased as the number of years after menopause increased in our study. However, we found that they were not the factors that influenced the prognosis of PTC.…”

Impact of Multifocality on the Recurrence of Papillary Thyroid Carcinoma

“…Feng et al showed that patients with multifocal PTCs had higher risk of large tumor size, ETE, vascular invasion, and LN metastasis [ 29 ]. Other researchers further indicated that multifocality was related with aggressive histologic subtype or higher ATA risk of recurrence [ 14 , 15 ]. A previous meta-analysis also suggested that multifocality was associated with an increased risk of tumor size >1 cm, ETE, and LN metastasis [ 13 ].…”

“…There is a controversy about the prognostic significance of multifocality in PTC. Several studies have suggested that multifocality is associated with a higher risk of recurrences and distant metastasis [ 13 , 14 , 15 ]. A few researchers further demonstrated that multifocal PTCs could decrease overall and cancer-specific survival [ 16 ].…”