The Shifting Landscape of Pediatric Papillary Thyroid Carcinoma: Forging a Connection Between Age and Invasive Disease

“Another nuance of the study is that even if the primary tumor was small (less than 1 cm) in the prepubertal cohort, the level of tumor aggressiveness still remains significant,” adds Dr. Finnerty. “This means even for the smallest tumors we should have a high index of suspicion for more aggressive disease.”

Regarding treatment, most pediatric patients in all of the age groups underwent a total thyroidectomy, although 7.2% of adolescents had a hemithyroidectomy compared with 4% of prepubertal children. Prophylactic lymphadenectomy was more frequent in young adults (50%) versus adolescents (30%) and prepubertal children (18%). Most pediatric patients received radioactive iodine therapy (63% of prepubertal and 59% of adolescents) as compared with 50% of young adults. Five-year survival did not differ between the age groups, with all three reporting a survival rate of higher than 99%.

“Our study data continues to support performing a total thyroidectomy in prepubertal children,” says Dr. Finnerty. “For these children, we still want to be fairly aggressive in our treatment approach by taking out the whole thyroid, because there's a higher likelihood of more aggressive cancer. However, in the adolescent population, there may be patient-specific factors that we can identify in the future that will help us apply a de-escalation approach for patients who may not need a total thyroidectomy.”

With its large sample size and statistical power, this study builds upon the knowledge base for pediatric PTC and provides a platform for more granular studies in the future. “Although the study provided meaningful insights, its limitations include the lack of recurrence rates or tumor genomics data to supplement our findings,” says Dr. Finnerty. “At Weill Cornell Medicine, we routinely use next-generation sequencing assays to assess the genomic profiles of thyroid tumors. Incorporating genomic profile data into a large-scale study would greatly enhance our ability to assess recurrence risk in children with these cancers.”

With its large sample size and statistical power, this study builds upon the knowledge base for pediatric PTC and provides a platform for more granular studies in the future. “Although the study provided meaningful insights, its limitations include the lack of recurrence rates or tumor genomics data to supplement our findings,” says Dr. Finnerty. “At Weill Cornell Medicine, we routinely use next-generation sequencing assays to assess the genomic profiles of thyroid tumors. Incorporating genomic profile data into a large-scale study would greatly enhance our ability to assess recurrence risk in children with these cancers.”

For Dr. Finnerty, NewYork-Presbyterian/Weill Cornell Medicine is the ideal setting to pursue research that would improve the management of children with PTC. “Looking toward the future, our main research questions are, can we deescalate the extent of thyroid surgery in an identifiable set of low-risk patients with PTC, and how can we incorporate tumor genomic factors into risk assessment to guide decision making, perhaps even preoperatively? Those are the future studies that I think are very much warranted.”