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Recurrence and morbidity in differentiated thyroid carcinoma in children

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      Abstract

      The management of differentiated thyroid cancer in childhood is controversial. In particular, the role of aggressive surgical treatment has been questioned. This study was performed to identify those factors that are predictive of recurrence and morbidity following treatment through use of a multivariate model. The records of all patients 17 years of age or less admitted in the last 35 years with histologically confirmed differentiated thyroid carcinoma were reviewed. Data were sufficient for multivariate analysis in 93. The mean age at diagnosis was 13.3 years, and the median period of follow-up was 20 years. Seventy-one percent of the patients had nodal metastases. There were no deaths from thyroid carcinoma in this series, and the overall recurrence rate after initial treatment was 34%. Multivariate analysis demonstrated that only age (p ≤ 0.07) and histologic subtype (p ≤ 0.01) were predictive of time to recurrence. Major morbidity was a function of age (p ≤ 0.007) and extent of thyroid surgery (p ≤ 0.01). Probability of minor complications was predicted by use of radical neck dissection (p ≤ 0.02). Use of total or subtotal thyroidectomy or of radical neck dissection in children does not prevent recurrence and is associated with an increased risk of complications. We conclude that these procedures should be avoided in pediatric patients.
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      References

        • Exelby PE
        • Frazell EL
        Carcinoma of the thyroid in children.
        Surg Clin North Am. 1969; 49: 249-259
        • Buckwalter JA
        • Thomas CG
        • Freeman JB
        Is childhood thyroid cancer a lethal disease?.
        Ann Surg. 1975; 181: 632-638
        • Withers EH
        • Rosenfeld L
        • O'Neill J
        • Lynch JB
        • Holcomb G
        Long-term experience with childhood thyroid carcinoma.
        J Pediatr Surg. 1979; 14: 332-335
        • Cady B
        • Rossi R
        • Silverman M
        • Wool M
        Further evidence of the validity of risk group definition in differentiated thyroid carcinoma.
        Surgery. 1985; 98: 1171-1178
        • Tollefsen HR
        • Shah JP
        • Huvos AG
        Papillary carcinoma of the thyroid.
        Am J Surg. 1972; 124: 468-472
        • Richardson JE
        • Beaugie' JM
        • Brown CL
        • Doniach I
        Thyroid cancer in young patients in Great Britain.
        Br J Surg. 1974; 61: 85-89
        • Cohn KH
        • Backdahl M
        • Forsslund G
        • et al.
        Biologic considerations and operative strategy in papillary thyroid carcinoma: arguments against the routine performance of total thyroidectomy.
        Surgery. 1984; 96: 957-968
        • Rossi RL
        • Cady B
        • Silverman ML
        • Wool MS
        • Horner TA
        Current results of conservative surgery for differentiated thyroid carcinoma.
        World J Surg. 1986; 10: 612-622
        • Schroder DM
        • Chambors A
        • France CJ
        Operative strategy for thyroid cancer: is total thyroidectomy worth the price?.
        Cancer. 1986; 58: 2320-2328
        • Tallroth E
        • Backdahl M
        • Einhorn J
        • Lundell G
        • Lowhagen T
        • Silfversward C
        Thyroid carcinoma in children and adolescents.
        Cancer. 1986; 58: 2329-2332
        • Thompson NW
        • Harness JK
        Complications of total thyroidectomy for carcinoma.
        Surg Gynecol Obstet. 1970; 131: 861-868
        • Liechty RD
        • Safaie-Shirazi S
        • Soper RT
        Carcinoma of the thyroid in children.
        Surg Gynecol Obstet. 1972; 134: 595-599
        • Attie JN
        • Moskowitz GW
        • Margouleff D
        • Levy LM
        Feasibility of total thyroidectomy in the treatment of thyroid carcinoma.
        Am J Surg. 1979; 138: 555-560
        • Tubiana M
        • Schlumberger M
        • Rougier P
        • et al.
        Long-term results and prognostic factors in patients with differentiated thyroid carcinoma.
        Cancer. 1985; 55: 794-804
        • Schlumberger M
        • De Vathaire F
        • Travagli JP
        • et al.
        Differentiated thyroid carcinoma in childhood: long-term follow-up of 72 patients.
        J Clin Endocrinol Metab. 1987; 65: 1088-1094
        • Razack MS
        • Sako K
        • Shimaoka K
        • Getaz EP
        • Rao U
        • Parthasarathy KL
        Radiation-associated thyroid carcinoma.
        J Surg Oncol. 1980; 14: 287-291
        • Halpern S
        Thyroid carcinoma in childhood.
        Med Pediatr Oncol. 1981; 9: 143-151
        • Peto R
        • Peto J
        Asymptotically efficient rank invariant test procedures.
        J R Statist Soc. 1972; 135: 185-206
        • Kaplan EL
        • Meier P
        Nonparametric estimation from incomplete observation.
        J Am Statist Assoc. 1958; 53: 457-481
        • Cox DR
        Regression models and life tables.
        J R Statist Soc. 1972; 34: 187-220
        • Cox DR
        Analysis of binary data.
        Methuen, London1970
        • Pizzo PA
        • Miser JS
        • Cassady JR
        • Filler RM
        Solid tumors of childhood.
        in: DeVita Jr, VT Hellman S Rosenberg SA Cancer: principles and practice of oncology. 2nd ed. JB Lippincott, Philadelphia1985: 1511-1516