Background/Objectives: Pediatric populations with well-differentiated thyroid cancer typically have favorable prognoses. However, the role of radioactive iodine (RAI) ablation in these patients remains uncertain. This investigation evaluates the national trends, therapeutic practices, and the impact of RAI on clinical outcomes. Methods: Patients aged 21 years or younger with differentiated thyroid cancer, identified from the SEER database between 2000 and 2019, were analyzed. We compared the treatment approaches and survival outcomes of patients who underwent RAI ablation with those who did not. Results: This retrospective cohort study encompassed 5318 pediatric patients, with 55.9% (n= 2973) who underwent RAI ablation. RAI utilization declined from 65% to 38.4% in 2019. Compared with those who did not undergo RAI, RAI patients presented with a larger tumor size (mean size: 27.7 vs. 20.4 mm), a higher T3/T4 stage (35.8% vs. 15.3%), nodal metastases (60.7% vs. 28.8%), and distant metastases (2.7% vs. 0.9%) (allp< 0.001). Despite this, RAI was not an independent predictor of recurrence, second malignancy, or mortality. The analysis showed no significant differences in long-term survival between the RAI and non-RAI groups (p> 0.05), with African American patients having an increased risk of mortality (HR = 3.81;p= 0.038). Cancer-directed surgery emerged as a protective factor (HR = 0.08;p= 0.018), while RAI treatment did not significantly affect mortality risk (p= 0.09). Conclusions: Excellent pediatric thyroid cancer outcomes were achieved regardless of RAI use. Further research should clarify appropriate RAI indications while addressing racial outcome inequities.
背景/目的：分化型甲状腺癌患儿通常预后良好，但放射性碘（RAI）消融在该人群中的作用仍不明确。本研究旨在评估RAI治疗的国家趋势、临床实践及其对预后的影响。方法：从SEER数据库中提取2000年至2019年间21岁及以下分化型甲状腺癌患者数据，比较接受与未接受RAI消融患者的治疗方案及生存结局。结果：本回顾性队列研究共纳入5318例患儿，其中55.9%（n=2973）接受RAI消融。RAI使用率从早期65%下降至2019年的38.4%。与未接受RAI治疗者相比，RAI组患者肿瘤更大（平均直径：27.7 mm vs. 20.4 mm）、T3/T4分期更高（35.8% vs. 15.3%）、淋巴结转移率（60.7% vs. 28.8%）及远处转移率（2.7% vs. 0.9%）均显著升高（所有p<0.001）。尽管如此，RAI并非肿瘤复发、第二原发癌或死亡的独立预测因子。长期生存分析显示RAI组与非RAI组无显著差异（p>0.05），非裔美国患者死亡风险更高（HR=3.81；p=0.038）。癌症根治性手术是保护性因素（HR=0.08；p=0.018），而RAI治疗对死亡风险无显著影响（p=0.09）。结论：无论是否使用RAI，儿童甲状腺癌均可获得良好预后。未来研究需明确RAI的适宜指征，同时关注不同种族间的预后差异。
肿瘤(癌症)患者之家