Clinicogenomic Model Stratifies Recurrence Risk in Pediatric Papillary Thyroid Cancer

A retrospective multicenter study published in The Journal of Clinical Endocrinology & Metabolism evaluated 435 patients aged 2–18 years with papillary thyroid carcinoma treated between 2006 and 2024. Researchers developed a disease-free survival (DFS) nomogram combining clinical characteristics, postoperative pathology, and molecular testing of surgical tissue. They compared its performance internally with the American Thyroid Association (ATA) pediatric risk system and assessed treatment associations within risk groups.

Five factors independently predicted worse DFS: age ≤15 years, tumor size >4 cm, lateral neck lymph node involvement (N1b), coexisting Hashimoto thyroiditis, and RET/NTRK fusions (all P <.05). Seven-year DFS was 92.4%, 83.1%, and 56.4% in the low-, intermediate-, and high-risk groups, respectively (P <.001). The nomogram had a higher concordance index than ATA stratification (0.721 vs 0.656) and a higher three-year area under the curve (0.748 vs 0.651; both P <.05).

Total thyroidectomy was associated with better DFS than lobectomy in intermediate- and high-risk patients, but not in low-risk patients. Postoperative radioactive iodine was associated with higher DFS in the high-risk group (P =.028). These findings suggest a potential risk-adapted treatment framework, but the retrospective associations cannot establish treatment benefit. Nonsignificant differences, particularly in small subgroups, do not demonstrate equivalence or support safe de-escalation. External validation is needed; assessment here is limited to the abstract.