Clinicopathological predictors of cervical lymph node metastases and disease persistence in pediatric papillary thyroid carcinoma: A single-center cohort study.

BACKGROUND

Papillary thyroid carcinoma (PTC) in children frequently presents with advanced locoregional disease, including cervical lymph node metastases. Identifying clinicopathological factors associated with nodal involvement and disease persistence may help refine surgical management and postoperative surveillance.

METHODS

We conducted a retrospective cohort study of pediatric patients undergoing total thyroidectomy with or without lymph node dissection at a tertiary referral center. Clinicopathological variables including tumor size, histological subtype, multifocality, extrathyroidal extension, and lymphovascular invasion were analyzed for their association with cervical lymph node metastases and disease-free survival.

RESULTS

The cohort included 83 patients with a mean age of 12.2 ± 2.8 years, with a predominance of females (73.5%). Cervical lymph node metastases were identified in 61.5% of patients, most commonly involving both central and lateral compartments. Tumor size, multifocality, extrathyroidal extension, lymphovascular invasion, and diffuse sclerosing variant were significantly associated with nodal metastases (p < 0.01). Patients younger than 10 years demonstrated a higher frequency of lateral neck metastases (p = 0.014). During a median follow-up of 1.9 years, structural disease persistence occurred in 37.3% of patients. In the univariate Cox regression analyses, lymphovascular invasion (HR 4.84; 95% CI 1.46-15.98; p = 0.01) and central lymph node metastasis (HR 3.28; p = 0.028) were associated with reduced disease-free survival.

CONCLUSIONS

In pediatric papillary thyroid carcinoma, several pathological features such as tumor size, multifocality, extrathyroidal extension, lymphovascular invasion, and diffuse sclerosing variant are strongly associated with cervical lymph node metastases. Lymphovascular invasion and central compartment nodal involvement were significant predictors of reduced disease-free survival, highlighting their potential value for risk stratification and postoperative management.

LEVEL OF EVIDENCE: Level III (retrospective cohort study).