Pediatric Thyroid Carcinoma: Incidence and Outcomes in 1753 Patients

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Objective

To examine outcomes and predictors of survival for pediatric patients with thyroid carcinoma.

Methods

The Surveillance, Epidemiology, and End Results (SEER) registry from 1973 to 2004 was queried for all patients with thyroid carcinoma less than 20 y of age.

Results

A total of 1753 patients with malignant thyroid neoplasms were identified with an age-adjusted annual incidence of 0.54 cases per 100,000 persons. There has been a significant increase in the annual incidence by 1.1% per y. Female patients outnumbered males 4 to 1. Tumors were classified as papillary (n = 1044, 60%), follicular variant of papillary (n = 389, 23%), follicular (n = 165, 10%), and medullary (n = 87, 5%). The majority of patients presented with localized and regional disease. Overall mean survival time (MST) was 30.5 y. The MST for females was 40 y, whereas males survived an average of 20.4 y (P = 0.0001). Patients with medullary cancer had significantly shorter mean survival than those with papillary cancer (P = 0.006). Surgical treatment significantly improved outcome. Multivariate analysis demonstrated that male gender, nonpapillary histology, distant disease, and no surgery were all independent prognostic factors of worse outcome. For patients with medullary thyroid carcinoma, radiation therapy was also identified as an independent predictor of lower survival.

Conclusion

The incidence of pediatric thyroid cancer is increasing. Females have a higher incidence than males, but enjoy longer survival. Papillary thyroid cancer has overall excellent survival. Male gender, nonpapillary tumor, distant metastases, and nonsurgical treatment all predict worse outcome.

Introduction

Thyroid cancer is the most common endocrine malignancy in children [1]. The predominant thyroid malignant histologies afflicting adults, namely papillary, follicular, and medullary cancer, are seen with similar frequency in children and adolescents. However, at the time of diagnosis, children present more often with advanced disease than adults 1, 2. Pediatric patients frequently present with lymph node involvement and distant metastases, which are amenable to surgical resection and radioactive iodine therapy in the case of thyroid cancers. These interventions have produced favorable outcomes within this patient population 3, 4, 5, 6.

Previous literature regarding pediatric thyroid carcinoma has consisted mostly of single-institutional series and more recently, a registry-based review [7]. We analyzed data from a national cancer registry in an effort to more extensively define the incidence, outcomes, and predictors of survival for childhood and adolescent thyroid carcinoma.

Section snippets

Methods

The latest SEER data, based on the April 2008 release, was used to identify all pediatric cases of thyroid carcinoma diagnosed from 1973 to 2004. A total of 1753 cases were extracted from the database by excluding patients over the age of 19. There were no duplicate cases in the sample. Tumor histology was identified using morphology code from the International Classification of Disease for Oncology, 3rd edition. Patients with missing data were excluded from each respective univariate and

Patient Demographics and Tumor Characteristics

A total of 1753 pediatric patients with thyroid carcinoma were identified during the study period. The annual incidence for thyroid cancer in 2004 was 0.54 cases per 100,000 (Table 1). The age-adjusted population incidence was 0.89 cases per 100,000 females and 0.2 cases per 100,000 males. The highest incidence was seen in white patients, adolescents (15–19 y olds), and papillary histology. Annual percent change (APC) detected a 1.1% increase in overall incidence per y (Fig. 1).

In our cohort,

Discussion

The Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI) is the largest registry of information on cancer incidence and survival in the United States [8]. The data is compiled from 17 population-based cancer registries, and encompasses approximately 26% of the U.S. population. The SEER program registers information on patient demographics, primary tumor site, tumor morphology, stage at diagnosis, first course of treatment, and follow-up for survival

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