S. Golpanian1, J. Tashiro1, J. I. Lew2, H. L. Neville1, J. E. Sola1, E. A. Perez1, A. R. Hogan1 1University Of Miami,Division Of Pediatric Surgery,Miami, FL, USA 2University Of Miami,Division Of Endocrine Surgery,Miami, FL, USA
Objective: To evaluate and update outcomes and predictors of survival of pediatric thyroid carcinoma, specifically examining pediatric patients with papillary thyroid carcinoma.
Methods: Surveillance, Epidemiology, and End Results database was searched for pediatric cases (<20 yrs old) of papillary thyroid carcinoma diagnosed between 1973 and 2011. Demographics, clinical characteristics, and survival outcomes were analyzed using standard statistical methods. All papillary types, including follicular variant were included in the data set.
Results: A total of 2,566 cases were identified. Overall incidence was 0.483/100,000 persons per year with a significant annual percent change (APC) of 2.07% (p<0.05). Mean age at diagnosis was 16 yrs old and highest incidence was found in white, female patients 15-19 yrs old. Patients whose tumor sizes were ≤1cm were more likely to receive lobectomies and/or isthmectomy versus subtotal/total thyroidectomies (OR=3.03 [2.12, 4.32]; p<0.001). When analyzed by propensity score matching by procedure, patients with larger tumors (≥1cm; p<0.001) and lymph node positive statuses (OR=99.0 [12.5, 783]; p<0.001) more likely underwent subtotal/total thyroidectomy compared to lobectomy and/or isthmetctomy. Mortality did not differ between procedures. When matched by tumor size, larger tumors (≥1cm) tended to be lymph node positive (OR=39.4 [16.6, 93.7]; p<0.001). Subtotal/total thyroidectomy patients were more likely to have distant disease, lymph node sampling (>10), and radiation treatment compared to those who underwent lobectomies and/or isthmectomies (p<0.001). Overall mean survival was 448 months and survival was highest in white females with regional disease. Overall 30-yr survival ranged from 89%-100%, regardless of tumor size or procedure type. Disease specific survival was highest in patients who received surgery, regardless of procedure type. Lymph node sampling did not affect overall or disease-specific survival. Multivariate analysis demonstrated that male gender was an independent predictor of poor prognosis (HR 8.074; p<0.0001).
Conclusions: The incidence of pediatric papillary thyroid cancer is increasing. Females have a higher incidence but also a better prognosis with improved survival than males. Tumors ≥1cm were highly likely to be lymph-node positive, but lymphadenectomy did not alter survival. Although larger tumors (≥1cm) were more likely to be resected by subtotal/total thyroidectomy, survival was high and did not differ based on procedure type.