Surgical Outcomes of Pediatric vs Adult Well-Differentiated Thyroid Cancer

Introduction: Despite the rising incidence of pediatric thyroid cancers, post-operative outcomes for such tumors have not been well-characterized. The objective of this study was to assess pathologic tumor characteristics and short-term outcomes of pediatric well-differentiated thyroid cancers relative to adult presentations.

Methods: This retrospective cohort study included pediatric ( < 18 years old) and adult (18+ years old) patients who underwent definitive surgery for well-differentiated thyroid cancer in the National Cancer Database from 2004-2020. Multivariable logistic and linear regression were used to compare pathologic tumor characteristics (pT/N/M upstaging, tumor size, tumor extension) and short-term surgical outcomes (30 day readmissions, length of stay [LOS], margin status, extent of lymph node removal) between groups.

Results: 3,623 (1.1%) pediatric and 334,690 (98.9%) adult patients were included in this study. In unadjusted analysis, pediatric patients had higher rates of pT and pN upstaging and tumor extension, and larger tumor size. Pediatric patients were also found to have a higher rate of surgical margin positivity, greater number of lymph nodes removed, and longer LOS. No differences were found in pM upstaging or 30 day readmissions. In multivariable analysis, pediatric patients continued to have a higher rate of nodal upstaging (OR-adj: 1.58, 95% CI: 1.36-1.84) and larger pathologic tumor size (β-adj: 4.91, 95% CI: 3.72-6.11) compared to adult patients. Pediatric patients also had a higher rate of margin positivity (OR-adj: 1.21, 95% CI: 1.02-1.42), greater number of lymph nodes removed (β-adj: 6.21, 95% CI: 5.33-7.09), and longer LOS (β-adj: 0.50, 95% CI: 0.21-0.78) compared to adult patients.

Conclusions: The findings of this study demonstrate that pediatric well-differentiated thyroid cancer is associated with worse pathologic and short-term outcomes than their adult counterparts, highlighting the need for personalized evaluation of this patient population. Further investigation is warranted on the impact of these findings on disease-specific survival of the younger population.