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Factors associated with distant metastasis in pediatric thyroid cancer: evaluation of the SEER database.

ABSTRACT: Objectives Controversies regarding factors associated with distant metastasis in pediatric thyroid cancer remain among the scientific community. The aim of this study was to investigate factors influencing distant metastasis in pediatric thyroid cancer. Methods We reviewed 1376 patients (aged 2 to 18 years) with thyroid cancer treated between 2003 and 2014. Data collected and analyzed included sex, race, age at diagnosis, year of diagnosis, pathological type, number of tumor foci, tumor extension, T-stage, N-stage, surgical procedure and radiation. Univariate and multivariate analyses were conducted to evaluate factors influencing distant metastasis of pediatric thyroid cancer. Results In the univariate analysis, factors influencing distant metastasis of thyroid cancer were age at diagnosis (P < 0.001), N-stage (P < 0.001), number of tumor foci (P = 0.003), tumor extension (P < 0.001) and T-stage (T1 vs T2 (P = 0.803), T3 (P < 0.001) and T4 (P < 0.001)). In multivariate analysis, factors influencing distant metastasis of thyroid cancer were age at diagnosis (P = 0.001), N-stage (P < 0.001) and T-stage (T1 vs T3 (P = 0.036) and T4 (P < 0.001)). Sex, race, year of diagnosis, pathological type, number of tumor foci, tumor extension, surgical procedure and radiation had no significant influence on distant metastasis (all P > 0.05). Furthermore, according to chi-squared test, younger pediatric thyroid cancer patients with higher T- and N-stages are more likely to have distant metastasis. Conclusion Age at diagnosis, T-stage and N-stage influence distant metastasis of thyroid cancer patients aged 2 to 18 years; accordingly, more radical treatments may need to be used for patients with those risk elements.

SUBMITTER: Liu Z

PROVIDER: S-EPMC6365667 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Factors associated with distant metastasis in pediatric thyroid cancer: evaluation of the SEER database.

Liu Zeming Z Hu Di D Huang Yihui Y Chen Sichao S Zeng Wen W Zhou Ling L Zhou Wei W Wang Min M Feng Haifeng H Wei Wei W Zhang Chao C Chen Danyang D Guo Liang L

Endocrine connections 20190201 2

Objectives Controversies regarding factors associated with distant metastasis in pediatric thyroid cancer remain among the scientific community. The aim of this study was to investigate factors influencing distant metastasis in pediatric thyroid cancer. Methods We reviewed 1376 patients (aged 2 to 18 years) with thyroid cancer treated between 2003 and 2014. Data collected and analyzed included sex, race, age at diagnosis, year of diagnosis, pathological type, number of tumor foci, tumor extensio ...[more]

PMID: 30620713

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Project description:BackgroundDespite their excellent prognosis, children and young adults (CAYA) with differentiated thyroid cancer (DTC) tend to have more frequent occurrence of distant metastasis (DM) compared to adult DTC. Data about DM in CAYA from Middle Eastern ethnicity is limited.MethodsMedical records of 170 patients with DTC ≤18 years were retrospectively reviewed. Clinico-pathological factors associated with lung metastasis in CAYA, their clinical presentation and outcome were analyzed. Rick factors related to distant metastasis-free survival (DMFS) for the whole cohort were evaluated.ResultsDM was observed in 27 patients and all were lung metastasis. Lung metastasis was significantly associated with younger age (≤15 years), extrathyroidal extension (ETE), multifocal tumors, bilaterality, presence of lymph node (LN) disease and high post-operative stimulated thyroglobulin (sTg). Highest negative predictive values were seen with low post-operative sTg (97.9%), absence of LN disease (93.8%), absence of ETE (92.2%) and age older than 15 years (92.9%). Post-therapy whole body scan (WBS) identified most of the lung metastasis (21 of 27; 77.8%). Upon evaluating patients response according to ATA guidelines, excellent response was seen in only one patient, while biochemical persistence and structural persistence were seen in 11.1% (3/27) and 77.8% (21/27), respectively. Elevated post-operative sTg (>10ng/ml) was the only risk factor found to be significantly associated with both biochemical persistence (with or without structural persistence (p = 0.0143)) and structural persistence (p = 0.0433). Cox regression analysis identified age and post-operative sTg as independent risk factors related to DMFS. Based on these two risk factors for DMFS, patients were divided into 3 groups: low risk (no risk factors), intermediate risk (1 risk factor) and high risk (both risk factors). 20-year DMFS rates in the low-, intermediate- and high-risk groups were 100.0%, 81.3% and 23.7% respectively (p < 0.0001).ConclusionHigher suspicion for metastatic pediatric DTC should be considered in patients who are young, have LN disease, extrathyroidal extension and elevated post-operative sTg. Persistent disease, despite therapy, is very common and it appears to be related to post-operative sTg level. Hence, risk adaptive management is desirable in CAYA with DTC.

Project description:BackgroundThe prognosis of hypopharyngeal squamous cell carcinoma (HPSCC) is poor due to its high incidence of local invasion and distant metastasis (DM). This study aims to explore the DM risk factors of HPSCC and establish a clinical prediction model.MethodsWe downloaded patient data from the Public Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2018. Univariate and multivariate logistic regression analyses were performed to screen the clinical risk factors for DM of HPSCC. A new nomogram prediction model was then established based on the selected clinical risk factors. We further validated the model's accuracy based on the concordance index (C-index), the area under the receiver operating characteristic (AUC) curve, and the calibration plot. The decision curve analysis (DCA) to test the potential clinical value of the new model was also applied.ResultsA total of 3502 patients were enrolled; the patients with HPSCC were randomly assigned to a training set (n=2463) and a validation set (n=1039). Multivariate Logistic model analysis suggested that sex, T stage, N stage, and the total number of tumors were influence factors for DM of HPSCC. We established and validated a novel nomogram prediction model based on the multivariate logistic model with these influence factors. The C-index was 0.943 and 0.849 in the training and validation sets respectively. The AUC of the training set was 0.705 (95% CI: 0.669-0.741), and the validation set was 0.667 (95% CI: 0.609-0.725). The calibration plot shows that the actual observation value was similar to the predicted value, meaning the model has an excellent discrimination ability. DCA of the nomogram in the training and validation sets suggested that our nomogram has potential application value.ConclusionsWe found that sex, T stage, N stage, and the total number of tumors are independent risk factors for DM of HPSCC. We developed a novel prediction model to predict DM in patients with HPSCC. This nomogram can identify patients with a high risk of DM and has a high clinical application value.

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Factors associated with distant metastasis in pediatric thyroid cancer: evaluation of the SEER database.

Publications

Factors associated with distant metastasis in pediatric thyroid cancer: evaluation of the SEER database.

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