Pathologic Characteristics and Surgical Outcomes of Pediatric Versus Adult Well-Differentiated Thyroid Cancer.

Objective: Despite the rising incidence of pediatric differentiated thyroid cancer (DTC), postoperative outcomes for such tumors have not been well-characterized. The objective of this study was to compare pathologic tumor characteristics and treatment outcomes for pediatric and adult patients with DTC.

Study design: Retrospective case-control study.

Setting: National database.

Methods: Pediatric (<18 years old) and adult (≥18 years old) patients who underwent surgery for DTC in the National Cancer Database (2004-2020) were included. Multivariable logistic, negative binomial, and linear regressions were used to compare pathologic tumor characteristics, treatment characteristics, and short-term surgical outcomes.

Results: 337,864 patients with DTC met the study eligibility criteria; 3584 (1.1%) were pediatric patients and 334,280 (98.9%) were adults. After adjustment, pediatric patients were found to have higher rates of pathologic T upstaging (adjusted odds ratio [OR_adj]: 1.40, 95% confidence interval [CI]: 1.23-1.59), N upstaging (OR_adj: 2.53, 95% CI: 2.23-2.88), and extrathyroidal extension (OR_adj: 1.58, 95% CI: 1.29-1.94), compared to adult patients. Pediatric patients were also more likely to receive neck dissection (OR_adj: 2.80, 95% CI: 2.55-3.07) and radioactive iodine (OR_adj: 1.42, 95% CI: 1.30-1.55). Pediatric patients had higher rates of positive surgical margins (OR_adj: 1.25, 95% CI: 1.11-1.41) and 30-day readmissions (OR_adj: 1.26, 95% CI: 1.00-1.58) than adult patients.

Conclusion: These findings demonstrate that pediatric DTC is associated with more aggressive disease presentations, more radical treatment, and worse short-term surgical outcomes compared to DTC in adults. Pediatric DTC should be considered a unique clinical entity that requires personalized evaluation and multidisciplinary treatment by specialized providers.