Table_1_A novel risk stratification model based on tumor size and multifocality to predict recurrence in pediatric PTC: comparison with adult PTC.docx

BackgroundPediatric papillary thyroid cancer presents with a more advanced stage of disease than adult PTC; and it is more likely to be aggresive and distant metastases, although the survival rate is high.
MethodsA retrospective observational study was performed in children and adults with PTC. Fisher’s exact, chi-square, and rank-sum tests were used to examine the differences. Univariate and multivariate Cox regression analyses were applied to determine the possible risk factors for prognosis. A Kaplan-Meier curve analysis was performed to investigate the relationship between the clinicopathological characteristics and recurrence rate.
ResultsThe study involved 156 children and 1,244 adults with PTC. Compared to the group without recurrence, proportions of tumors measuring > 1 cm (48.3% vs. 90.9%) and multifocality (30.3% vs. 63.6%) were higher, N1b stage occurred more frequently (33.8% vs. 100%). However, among adult PTC patients, those with recurrence were older (76.1% vs. 59.4%) than those without recurrence. Risk factors for pediatric PTC recurrence included tumor size and multifocality. However, in adult PTC, the risk factor was LLNM. The newly constructed Stratification.N showed better performance, as illustrated by the fact that patients who were classified into Stratification.N 3 showed an obviously poorer prognosis (P=0.01 and P=0.00062), especially in those aged >14 years (P=0.0052).
ConclusionCompared with adult PTC, pediatric PTC showed unique characteristics in terms of clinical pathology and recurrence. Tumor size and multifocality were strong risk factors for pediatric PTC. Accordingly, the novel proposed risk stratification method could effectively predict the recurrence of pediatric PTC.

研究背景：儿童甲状腺乳头状癌（pediatric papillary thyroid cancer）的临床分期较成人甲状腺乳头状癌（PTC）更晚，且更具侵袭性、更易发生远处转移，尽管其总体生存率较高。
研究方法：本研究针对甲状腺乳头状癌（PTC）患儿及成人患者开展了一项回顾性观察研究。采用Fisher确切概率法、卡方检验及秩和检验分析组间差异；通过单因素及多因素Cox回归分析筛选预后相关潜在危险因素；采用Kaplan-Meier曲线分析探讨临床病理特征与复发率之间的关联。
研究结果：本研究共纳入156例儿童甲状腺乳头状癌患者及1244例成人甲状腺乳头状癌患者。与无复发组相比，复发组中肿瘤直径＞1cm者占比（48.3% vs 90.9%）、肿瘤多灶性占比（30.3% vs 63.6%）均更高，N1b期患者占比也更为突出（33.8% vs 100%）。但在成人甲状腺乳头状癌患者中，复发组年龄偏高者的占比高于无复发组（76.1% vs 59.4%）。儿童甲状腺乳头状癌复发的危险因素包括肿瘤直径及多灶性；而成人甲状腺乳头状癌复发的危险因素为侧方淋巴结转移（LLNM）。新构建的Stratification.N分层模型表现更优：被归为Stratification.N 3级的患者预后显著更差（P=0.01及P=0.00062），在年龄＞14岁的患者中这一差异尤为显著（P=0.0052）。
研究结论：与成人甲状腺乳头状癌相比，儿童甲状腺乳头状癌在临床病理特征及复发风险方面均存在独特性。肿瘤直径与多灶性是儿童甲状腺乳头状癌复发的重要危险因素。因此，本研究提出的新型风险分层模型可有效预测儿童甲状腺乳头状癌的复发风险。