Thyroid cancer in children: A multicenter international study highlighting clinical features and surgical outcomes of primary and secondary tumors
Cristina Martucci, Alessandro Crocoli, Maria Debora De Pasquale, Claudio Spinelli, Silvia Strambi, Paolo Brazzarola, Eleonora Morelli, Jessica Cassiani, Juliana Mancera, Juan Pablo Luengas, Pablo Lobos, Daniel Liberto, Estefanìa Astori, Sabine Sarnacki, Vincent Couloigner, François Simon, Cassandre Lambert, Simone de Campos Vieira Abib, Onivaldo Cervantes, Eliana Maria Monteiro Caran, Diana Delgado Lindman, Matthew Jones, Rajeev Shukla, Paul D. Losty, Alessandro Inserra
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%).