Journal article
A National Perspective of the Risk, Presentation, and Outcomes of Pediatric Thyroid Cancer
JAMA otolaryngology-- head & neck surgery, Vol.142(5), pp.472-478
05/01/2016
DOI: 10.1001/jamaoto.2016.0104
PMID: 27031884
Abstract
Thyroid cancer is the most common endocrine malignant neoplasm in children and adolescents. Despite a more advanced presentation of thyroid cancer, younger patients tend to have a more favorable prognosis and a lower mortality rate than adults with thyroid cancer.
To examine the presentation and outcomes of thyroid cancer in pediatric patients.
A cross-sectional weighted analysis was performed using data from the Nationwide Inpatient Sample from January 1, 2003, to December 31, 2010. Patient data were derived from a sample of 20% of community hospitals in the United States. Six hundred forty-four children and adolescents (age, <18 years; hereinafter referred to as children) with thyroid cancer were compared with 43 536 adults (age, ≥18 years) with thyroid cancer. Data were analyzed from December 7, 2014, to November 19, 2015.
Thyroid cancer and thyroidectomy.
Presentation and management characteristics of thyroid cancer and thyroidectomy outcomes in relation to surgeon volume and specialty.
A total of 644 cases of pediatric thyroid cancer were included (female, 77.3%; mean [SEM] age, 13.8 [0.2] years), corresponding to a weighted sample of 32 563. Compared with adults with thyroid cancer, children were more likely to present with cervical lymph node involvement (31.5% vs 14.7%; odds ratio [OR], 2.29; 95% CI, 1.76-2.97; P < .001) and lung metastases (5.7% vs 2.2%; OR, 2.79; 95% CI, 1.82-4.28; P < .001), whereas bone metastases were more frequent in adults (0.3% vs 1.1%; OR, 0.23; 95% CI, 0.06-0.90; P = .04). Children were more likely to be treated by a low-volume surgeon (26.9% vs 16.0%; OR, 2.09; 95% CI, 1.26-3.48; P = .005) or a pediatric surgeon (14.5% vs 9.6%; OR, 1.66; 95% CI, 1.04-2.67; P = .04) and in a low-volume hospital (20.5% vs 15.2%; OR, 2.97; 95% CI, 1.60-5.54; P < .001) or a teaching hospital (81.7% vs 63.1%; OR, 3.61; 95% CI, 2.33-5.60; P < .001). Compared with those treated by low-volume surgeons, children treated by high-volume surgeons were less likely to experience postoperative complications (14.3% vs 35.9%; OR, 0.16; 95% CI, 0.05-0.51; P = .002) or a hospital stay of more than 1 day (49.8% vs 67.9%; OR, 0.36; 95% CI, 0.15-0.90; P = .03). Management by pediatric surgeons did not significantly alter the risk for postoperative complications compared with other specialties (21.3% vs 18.5%; OR, 1.71; 95% CI, 0.64-4.53, P = .28). Management of thyroid cancer in children was significantly more costly (>$10 067.08/case) compared with adults (P = .04).
Compared with thyroid cancer in adults, pediatric thyroid cancer is more likely to present as advanced disease and to be managed by low-volume or pediatric surgeons. In addition, within the United States, surgeon volume appears to be more crucial in determining thyroidectomy outcomes than the surgeon's field of specialization.
Details
- Title: Subtitle
- A National Perspective of the Risk, Presentation, and Outcomes of Pediatric Thyroid Cancer
- Creators
- Zaid Al-Qurayshi - Tulane UniversityAdam Hauch - Tulane UniversitySudesh Srivastav - Tulane UniversityRizwan Aslam - Tulane UniversityPaul Friedlander - Tulane UniversityEmad Kandil - Tulane University
- Resource Type
- Journal article
- Publication Details
- JAMA otolaryngology-- head & neck surgery, Vol.142(5), pp.472-478
- DOI
- 10.1001/jamaoto.2016.0104
- PMID
- 27031884
- ISSN
- 2168-6181
- eISSN
- 2168-619X
- Language
- English
- Date published
- 05/01/2016
- Academic Unit
- Otolaryngology
- Record Identifier
- 9984702817002771
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