Clinical characteristics, surgical approaches, and prognosis of follicular and papillary thyroid cancer in children and adolescents: a retrospective cohort study

PurposeFollicular and papillary thyroid cancers are prevalent endocrine tumors in children and adolescents. This study seeks to highlight distinctions between papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) to inform subtype-specific guidelines.Patients and methodsUtilizing data from the SEER database, this study contrasts the clinical features, survival rates, causes of death, TNM staging, and surgical interventions for pediatric and adolescent patients diagnosed with PTC and FTC from 2000 to 2020.ResultsWe analyzed 3068 pediatric and adolescent patients with differentiated thyroid cancer (DTC). Since 2005, PTC incidence has increased, while FTC remains stable. Both subtypes exhibit excellent survival rates; FTC shows near-perfect outcomes, and PTC's overall survival (OS) at 2, 5, and 10 years is 99.6, 99.2, and 98.5%, respectively. Thyroid cancer accounted for only 20.9% of deaths among PTC patients. Significant differences in T and N staging were observed. Regarding surgery, 70% of FTC patients underwent total or near-total thyroidectomy compared to 90% of PTC patients. Lymph node dissection was performed in 41.7% of FTC and 77.5% of PTC patients, indicating distinct surgical approaches.ConclusionPediatric and adolescent patients with FTC and PTC have excellent prognoses. The extent of thyroidectomy and criteria for prophylactic central lymph node dissection should be tailored specifically for FTC and PTC, rather than generalizing under DTC.Clinical trial informationNCT06592118.