Relationship between recurrence and age in the diffuse sclerosing variant of papillary thyroid carcinoma: clinical significance in pediatric patients

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Authors: Junu Kim ; Ja Seung Koo ; Ji-In Bang ; Jin Kyong Kim ; Sang-Wook Kang ; Jong Ju Jeong ; Kee-Hyun Nam ; Woong Youn Chung

MeSH: Adolescent ; Adult ; Age Factors ; Aged ; Child ; Child, Preschool ; Clinical Relevance ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local* / epidemiology ; Neoplasm Recurrence, Local* / pathology ; Prognosis ; Retrospective Studies ; Thyroid Cancer, Papillary* / pathology ; Thyroid Cancer, Papillary* / surgery ; Thyroid Neoplasms* / epidemiology ; Thyroid Neoplasms* / pathology ; Thyroid Neoplasms* / surgery ; Thyroidectomy ; Young Adult

Keywords: diffuse sclerosing variant ; papillary thyroid cancer ; pediatrics ; prognosis ; thyroid cancer ; thyroid neoplasm

Abstract: Background: The diffuse sclerosing variant (DSV) is among the aggressive variants of papillary thyroid carcinoma (PTC) and is more prevalent in pediatric patients than in adult patients. Few studies have assessed its characteristics owing to its low incidence. We aimed to evaluate the relationship between recurrence and age in the DSV of PTC.

Methods: We retrospectively reviewed patients diagnosed with the DSV or conventional PTC (cPTC) after surgery at a medical center between May 1988 and January 2019. We compared the clinico-pathological characteristics and surgical outcomes of the DSV and cPTC groups and between adult and pediatric patients with DSV.

Results: Among the 24,626 patients, 202 had the DSV, and 24,424 were diagnosed with cPTC. The recurrence rate was significantly higher in the DSV group than in the cPTC group. In the DSV group, the recurrence rate was significantly higher in the pediatric patient group than in the adult patient group. Moreover, the association between recurrence and age group showed different patterns between the DSV and cPTC groups with restricted cubic splines (RCS). While both RCS curves showed a U-shaped distribution, the RCS curve tended to be located within the younger age group.

Conclusions: This study demonstrated that pediatric patients with DSV are at a greater risk for recurrence compared with adult patients; moreover, the pattern of recurrence risk according to age is different from that of cPTC.