Risk factors of lymph node metastasis in the diffuse sclerosing variant of papillary thyroid carcinoma compared with conventional papillary thyroid carcinoma in pediatric populations

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology Pub Date : 2024-11-25 DOI:10.1016/j.oraloncology.2024.107120

Yanan Liu , Nantao Fu , Haitao Liu , Shanshan Su , Tingting Yang , Ping Long , Wei Zhong , Xiang Min

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Abstract

Objective

To analyze the clinicopathological features and predictors of lymph node metastasis (LNM) in the diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) and compare these findings with conventional papillary thyroid carcinoma (C-PTC) in pediatric populations.

Methods

Patients aged 18 years or younger who were preoperatively diagnosed with PTC and underwent thyroidectomy at the First Affiliated Hospitals of Nanchang University from January 2017 to May 2024 were included in this study. Demographic and clinicopathological characteristics were retrospectively analyzed. Univariate and multivariate analyses were performed to identify risk factors for lymph node metastasis. Clinical outcomes, including nerve injury, hypocalcemia, and recurrence, were also recorded and evaluated.

Results

A total of 119 children were enrolled in this study, with a median age of 15.6 years. Of these, 89 (74.8 %) were female, and 18 (15.1 %) were diagnosed with DSV-PTC. Central lymph node metastasis (CLNM) was observed in 94 (79 %) patients, while 60 (50.4 %) had lateral lymph node metastasis (LLNM). DSV-PTC was associated with a higher incidence of CLNM and LLNM compared to C-PTC (p = 0.039, p < 0.001). Multifocality and bilateral tumors were also more common in DSV-PTC (p < 0.001). Cox regression analysis identified tumor size as an independent predictive factor for CLNM in pediatric C-PTC patients. Tumor size, ETE and the presence of CLNM were independent predictive factors for LLNM. After a mean follow-up of 32.8 months, no patient died from the disease, but four C-PTC patients (4.0 %) developed local recurrences, which were managed surgically. Lung metastasis occurred in 2 (11.1 %)

DSV-PTC and 1(1.0 %)C-PTC patients, respectively. Permanent injuries included one case of unilateral recurrent laryngeal nerve(RLN) injury and two cases of bilateral RLN injury. Four patients (4.0 %) experienced temporary hypocalcemia, which resolved after 6 months of calcium therapy.

Conclusions

DSV-PTC presents unique characteristics of lymph node metastasis and may be more aggressive than conventional PTC in pediatric populations. The presence of CLNM, tumor size and ETE were identified as independent predictors of LLNM in pediatric patients with conventional PTC. Evaluating these prognostic factors may help in customizing individualized surgical approaches for children, thereby reducing unnecessary surgical complications.

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与儿科人群中的传统甲状腺乳头状癌相比，弥漫硬化型甲状腺乳头状癌淋巴结转移的风险因素

目的分析弥漫硬化变异型甲状腺乳头状癌（DSV-PTC）的临床病理特征和淋巴结转移（LNM）的预测因素，并将这些结果与儿科人群中的传统甲状腺乳头状癌（C-PTC）进行比较。方法纳入2017年1月至2024年5月在南昌大学第一附属医院术前诊断为PTC并接受甲状腺切除术的18岁或以下患者。回顾性分析了人口统计学和临床病理学特征。进行单变量和多变量分析以确定淋巴结转移的风险因素。研究还记录并评估了临床结果，包括神经损伤、低钙血症和复发。其中 89 名（74.8%）为女性，18 名（15.1%）被诊断为 DSV-PTC。94名患者（79%）出现中央淋巴结转移（CLNM），60名患者（50.4%）出现侧淋巴结转移（LLNM）。与 C-PTC 相比，DSV-PTC 的 CLNM 和 LLNM 发生率更高（p = 0.039，p < 0.001）。多灶性和双侧肿瘤在 DSV-PTC 中也更为常见（p < 0.001）。Cox回归分析发现，肿瘤大小是儿科C-PTC患者CLNM的独立预测因素。肿瘤大小、ETE和CLNM的存在是LLNM的独立预测因素。经过平均 32.8 个月的随访，没有患者死于该病，但有 4 名 C-PTC 患者（4.0%）出现局部复发，并通过手术进行了治疗。肺转移分别发生在 2 例（11.1%）DSV-PTC 和 1 例（1.0%）C-PTC 患者身上。永久性损伤包括一例单侧喉返神经损伤和两例双侧喉返神经损伤。4例患者（4.0%）出现暂时性低钙血症，经过6个月的钙剂治疗后缓解。CLNM 的存在、肿瘤大小和 ETE 被确定为传统 PTC 儿童患者淋巴结转移的独立预测因素。评估这些预后因素有助于为儿童定制个性化的手术方法，从而减少不必要的手术并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oral oncology 医学-牙科与口腔外科

CiteScore

8.70

自引率

10.40%

发文量

505

审稿时长

20 days

期刊介绍： Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck. Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.