Utilization of Total Thyroidectomy for Differentiated Thyroid Cancer in Children
- 144 Downloads
Recent recommendations suggest that total thyroidectomy (TT) is the surgical management of choice for differentiated thyroid cancer in children. The objective of this study is to assess trends in extent of surgical resection for differentiated thyroid cancer in children over the past two decades and to identify patient, tumor or hospital factors associated with use of TT.
Patients and Methods
Of 8,013 patients (aged 0–21 years) with differentiated thyroid cancer from the National Cancer Data Base (1985–2007), 5,933 (74%) underwent TT. Trends in extent of surgery were examined. Logistic regression was used to identify factors that predict use of TT.
Use of TT increased from 50.6% in 1985 to 84% in 2007 (P < 0.001). Patients were more likely to undergo TT if they had higher household income or had private insurance (P = 0.002 and P = 0.037). Patients were more likely to undergo TT if they had larger tumors or if there were nodal metastases present at time of resection (both P < 0.001). After adjusting for patient and tumor factors, patients treated at high-volume or Children’s Oncology Group hospitals were more likely to undergo TT than patients treated at low-volume or non-Children’s Oncology Group hospitals (P < 0.001).
Overall utilization of TT in children with differentiated thyroid cancer has steadily increased over the past 23 years in the USA. Variations in use of TT are not only related to tumor factors including size and nodal involvement, but also are also related to socioeconomic and hospital factors, demonstrating disparities in care.
KeywordsThyroid Cancer Total Thyroidectomy Papillary Thyroid Cancer Differentiate Thyroid Cancer National Cancer Data Base
M.V.R. participates in the American College of Surgeons Clinical Scholars in Residence Program. M.V.R. is supported by the John Gray Research Fellowship and the Daniel F. and Ada L. Rice Foundation. D.J.B. is supported by a career development award from the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service. The National Cancer Data Base is supported by the American College of Surgeons, Commission on Cancer, and the American Cancer Society.
- 1.Ries LAG, Smith MA, Gurney JG, et al. Cancer Incidence and Survival among Children and Adolescents: United States SEER Program 1975-1995, National Cancer Institute, SEER Program. Bethesda, MD: NIH Pub. No. 99-4649, 1999.Google Scholar
- 8.La Quaglia MP, Black T, Holcomb GW, 3rd, et al. Differentiated thyroid cancer: clinical characteristics, treatment, and outcome in patients under 21 years of age who present with distant metastases. A report from the Surgical Discipline Committee of the Children’s Cancer Group. J Pediatr Surg. 2000;35(6):955–9; discussion 960.Google Scholar
- 9.National Cancer Data Base. 2008. Available at www.facs.org/cancer/ncdb. Accessed April 22, 2010.
- 10.Commission on Cancer: Approval Categories. 2008. Available at www.facs.org/cancer/coc/categories.html, Vol. last revised August 30, 2005.
- 15.Childrens Oncology Group Cure Search. 2009. Available at http://www.childrensoncologygroup.org/, Vol. January 19, 2009.
- 16.National Cancer Institute: SEER Surveillance Epidemiology and End Results. 2008. Available at www.seer.cancer.gov. Accessed April 22, 2010.
- 17.National Program of Cancer Registries (NPCR): Cancer Surveillance System Rationale and Approach. 2008. Available at www.cdc.gov/cancer/npcr/. Accessed April 22, 2010.
- 18.National Cancer Registrars Association: Certification. 2008. Available at www.ncra-usa.org/. Accessed April 22, 2010.
- 20.International Classification of Diseases for Oncology. 3rd ed. Geneva: World Helath Organization, 2000.Google Scholar
- 21.FORDS: Facility Oncolgy Registry Data Standards—Revised for 2007. Chicago, IL: Commision on Cancer, American College of Surgeons, 2007.Google Scholar
- 22.U.S. Census Bureau. 2008. Available at http://www.census.gov/main/www/cen2000.html. Accessed April 22, 2010.
- 34.Wada N, Sugino K, Mimura T, et al. Pediatric differentiated thyroid carcinoma in stage I: risk factor analysis for disease free survival. BMC Cancer. 2009;9:306.Google Scholar
- 39.Halac I, Zimmerman D. Thyroid nodules and cancers in children. Endocrinol Metab Clin North Am. 2005;34(3):725–44, x.Google Scholar