Pathologic Characteristics and Surgical Outcomes of Pediatric Versus Adult Well‐Differentiated Thyroid Cancer

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Abstract Objective Despite the rising incidence of pediatric differentiated thyroid cancer (DTC), postoperative outcomes for such tumors have not been well‐characterized. The objective of this study was to compare pathologic tumor characteristics and treatment outcomes for pediatric and adult patients with DTC. Study Design Retrospective case‐control study. Setting National database. Methods Pediatric (<18 years old) and adult (≥18 years old) patients who underwent surgery for DTC in the National Cancer Database (2004‐2020) were included. Multivariable logistic, negative binomial, and linear regressions were used to compare pathologic tumor characteristics, treatment characteristics, and short‐term surgical outcomes. Results 337,864 patients with DTC met the study eligibility criteria; 3584 (1.1%) were pediatric patients and 334,280 (98.9%) were adults. After adjustment, pediatric patients were found to have higher rates of pathologic T upstaging (adjusted odds ratio [ORadj]: 1.40, 95% confidence interval [CI]: 1.23‐1.59), N upstaging (ORadj: 2.53, 95% CI: 2.23‐2.88), and extrathyroidal extension (ORadj: 1.58, 95% CI: 1.29‐1.94), compared to adult patients. Pediatric patients were also more likely to receive neck dissection (ORadj: 2.80, 95% CI: 2.55‐3.07) and radioactive iodine (ORadj: 1.42, 95% CI: 1.30‐1.55). Pediatric patients had higher rates of positive surgical margins (ORadj: 1.25, 95% CI: 1.11‐1.41) and 30‐day readmissions (ORadj: 1.26, 95% CI: 1.00‐1.58) than adult patients. Conclusion These findings demonstrate that pediatric DTC is associated with more aggressive disease presentations, more radical treatment, and worse short‐term surgical outcomes compared to DTC in adults. Pediatric DTC should be considered a unique clinical entity that requires personalized evaluation and multidisciplinary treatment by specialized providers.

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