Pediatric differentiated thyroid carcinoma in stage I: risk factor analysis for disease free survival

We reviewed 57 consecutive TNM stage I patients (15 years or less) with DTC (46 papillary and 11 follicular) who underwent initial treatment at Ito Hospital between 1962 and 2004 (7 males and 50 females; mean age: 13.1 years; mean follow-up: 17.4 years). Clinicopathological results were evaluated in all patients. Multivariate analysis was performed to reveal the risk factors for disease-free survival (DFS) in these 57 patients.Extrathyroid extension and clinical lymphadenopathy at diagnosis were found in 7 and 12 patients, respectively. Subtotal/total thyroidectomy was performed in 23 patients, modified neck dissection in 38, and radioactive iodine therapy in 10. Pathological node metastasis was confirmed in 37 patients (64.9%). Fifteen patients (26.3%) exhibited local recurrence and 3 of them also developed metachronous lung metastasis. Ten of these 15 achieved disease-free after further treatments and no patients died of disease. In multivariate analysis, male gender (p = 0.017), advanced tumor (T3, 4a) stage (p = 0.029), and clinical lymphadenopathy (p = 0.006) were risk factors for DFS in stage I pediatric patients.Male gender, tumor stage, and lymphadenopathy are risk factors for DFS in stage I pediatric DTC patients. Aggressive treatment (total thyroidectomy, node dissection, and RI therapy) is considered appropriate for patients with risk factors, whereas conservative or stepwise approach may be acceptable for other patients.Differentiated thyroid carcinoma (DTC) is rare in pediatric patients. The incidence of this form has been reported to range from 2.6% to 12.9% of whole DTC population treated during the same period [1-11]. Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy in pediatric patients as well as in adult patients [1-35]. Radiation exposure in infancy has been reported to be associated with the possible occurrence of PTC [12,13]. Follicular thyroid carcinoma (FTC) is the next common form, but is usually quite rare in pediatri