Background
High-risk prognostic factors for adults with well-differentiated thyroid cancer (WDTC)
have been well established, but the same is not true for pediatric patients. This
study sought to determine whether validated adult prognostic systems are applicable
to pediatric patients and to develop a novel prognostic scale that may better reflect
outcomes in pediatric subgroups.
Methods
We queried 62,007 cases of WDTC from the Surveillance, Epidemiology, and End Results
(SEER) database (1973–2009) to identify 895 patients <20 years of age with WDTC. Data
abstracted included age, gender, race, histology type, primary tumor size, cancer
stage, and mortality. Odds ratio and 95% confidence intervals were set and data were
analyzed with SAS version 9.2.
Results
Among 895 pediatric WDTC patients, the overall cause-specific mortality was 0.8%.
The presence of distant metastasis was associated with the worst prognosis (P = .0045) followed by larger primary tumor size (P = .0135) and male gender (P = .0162). When classified into low-, moderate-, and high-risk categories according
to the distant metastasis (Me), larger primary tumor size (S), and male sex (S) (MeSS)
algorithm, mortality rates were 0%, 2.7%, and 23%, respectively.
Conclusion
Commonly used prognostic indices for WDTC in adults do not reliably predict poor outcomes
among pediatric patients. Rather, a system based on MeSS is more applicable to pediatric
patients. Patients who exhibit a high MeSS score have a significantly worse overall
survival than those who do not express any MeSS characteristics.
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References
- Papillary thyroid cancer: monitoring and therapy.Endocrinol Metab Clin North Am. 2007; 36: 753-778
SEER*Stat Database: Incidence - SEER 9 Regs Research Data, Nov 2010 Sub (1973-2009) Katrina/Rita Population Adjustment - Linked To County Attributes - Total US, 1969-2009 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2011, based on the November 2010 submission. SEER; Available from: http://www.seer.cancer.gov.
- Papillary thyroid carcinoma in children and adults: long-term follow-up of 1039 patients conservatively treated at one institution during three decades.Surgery. 1988; 104: 1157-1166
- Thyroid carcinoma in children and adolescents.Eur J Pediatric. 1997; 156: 190-194
- Differentiated thyroid carcinoma in children and adolescents: a 37-year experience in 85 patients.J Nucl Med. 1997; 38: 669-675
- Surgery of thyroid cancer in children and adolescents.Head Neck. 1998; 20: 293-297
- Clinical features of differentiated thyroid carcinoma in children and adolescents from a sub-Himalayan iodine-deficient endemic zone.Nucl Med Commun. 2001; 22: 881-887
- Well-differentiated thyroid carcinoma in Hong Kong Chinese patients under 21 years of age: a 35-year experience.J Am Coll Surg. 2002; 194: 711-716
- Thyroid cancer in children: management and outcome experience of a referral center.Otolaryngol Head Neck Surg. 2006; 135: 581-584
- Clinical features associated with metastasis and recurrence of differentiated thyroid cancer in children, adolescents and young adults.Clin Endocrinol (Oxf). 1998; 9: 619-628
- Pediatric thyroid cancer.J Surg Oncol. 2005; 92: 130-133
- Recurrence and morbidity in differentiated thyroid carcinoma in children.Surgery. 1988; 104: 1149-1156
- Carcinoma of the thyroid in children: a 25-year experience.Med Pediatr Oncol. 1997; 29: 103-107
- Papillary carcinoma of the thyroid gland of childhood and adolescence: morphologic subtypes, biologic behavior and prognosis: a clinicopathologic study of 42 sporadic cases treated at a single institution during a 30-year period.Am J Surg Pathol. 2006; 30: 1420-1426
- Papillary thyroid cancer with pulmonary metastases in children: long-term prognosis.Surgery. 2000; 128: 881-886
- Prognostic factors of a good response to initial therapy in children and adolescents with differentiated thyroid cancer.Clinics (Sao Paulo). 2011; 66: 281-286
- Prognostic variables of papillary and follicular thyroid carcinoma patients with lymph node metastases and without distant metastases.Endocr Relat Cancer. 1999; 6: 109-115
- Staging systems for papillary thyroid carcinoma: a review and comparison.Ann Surg. 2007; 245: 366-378
- Sociodemographic predictors of survival in differentiated thyroid cancer: results from the SEER Database.ISRN Endocrinol. 2012; : 384707
- BRAF gene mutation in the natural history of papillary thyroid carcinoma: diagnostic and prognostic implications.Acta Med Port. 2011; 24 ([Article in Portuguese]): 855-868
- The prevalence and prognostic value of BRAF mutation in thyroid cancer.Ann Surg. 2007; 246: 466-470
- The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma.Cancer. 2005; 103: 2269-2273
- Cancer of the thyroid.in: Ries L.A.G. Young J.L. Keel G.E. Eisner M.P. Lin Y.D. Horner M.J. SEER survival monograph: cancer survival among adults. U.S. SEER program, 1988-2001, patient and tumor characteristics. National Cancer Institute, SEER Program, NIH, Bethesda (MD)2007
- Thyroid cancer incidence patterns in the United States by histologic type, 1992-2006.Thyroid. 2011; 21: 125-134
- Effect of race on thyroid cancer care in an equal access healthcare system.Am J Surg. 2010; 199: 685-689
Article info
Publication history
Accepted:
April 24,
2013
Identification
Copyright
© 2013 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
