Annals of Surgical Oncology

, Volume 17, Issue 10, pp 2545–2553 | Cite as

Utilization of Total Thyroidectomy for Differentiated Thyroid Cancer in Children

  • Mehul V. Raval
  • David J. Bentrem
  • Andrew K. Stewart
  • Clifford Y. Ko
  • Marleta Reynolds
Healthcare Policy and Outcomes

Abstract

Purpose

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.

Results

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).

Conclusions

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.

Keywords

Thyroid Cancer Total Thyroidectomy Papillary Thyroid Cancer Differentiate Thyroid Cancer National Cancer Data Base 

Notes

Acknowledgment

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.

References

  1. 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
  2. 2.
    Hogan AR, Zhuge Y, Perez EA, et al. Pediatric thyroid carcinoma: incidence and outcomes in 1753 patients. J Surg Res. 2009;156(1):167–72.CrossRefPubMedGoogle Scholar
  3. 3.
    Demidchik YE, Demidchik EP, Reiners C, et al. Comprehensive clinical assessment of 740 cases of surgically treated thyroid cancer in children of Belarus. Ann Surg. 2006;243(4):525–32.CrossRefPubMedGoogle Scholar
  4. 4.
    Okada T, Sasaki F, Takahashi H, et al. Management of childhood and adolescent thyroid carcinoma: long-term follow-up and clinical characteristics. Eur J Pediatr Surg. 2006;16(1):8–13.CrossRefPubMedGoogle Scholar
  5. 5.
    Dinauer CA, Breuer C, Rivkees SA. Differentiated thyroid cancer in children: diagnosis and management. Curr Opin Oncol. 2008;20(1):59–65.CrossRefPubMedGoogle Scholar
  6. 6.
    Grigsby PW, Gal-or A, Michalski JM, Doherty GM. Childhood and adolescent thyroid carcinoma. Cancer. 2002;95(4):724–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16(2):109–42.CrossRefPubMedGoogle Scholar
  8. 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. 9.
    National Cancer Data Base. 2008. Available at www.facs.org/cancer/ncdb. Accessed April 22, 2010.
  10. 10.
    Commission on Cancer: Approval Categories. 2008. Available at www.facs.org/cancer/coc/categories.html, Vol. last revised August 30, 2005.
  11. 11.
    Winchester DP, Stewart AK, Bura C, Jones RS. The National Cancer Data Base: a clinical surveillance and quality improvement tool. J Surg Oncol. 2004;85(1):1–3.CrossRefPubMedGoogle Scholar
  12. 12.
    Bilimoria KY, Stewart AK, Winchester DP, Ko CY. The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol. 2008;15(3):683–90.CrossRefPubMedGoogle Scholar
  13. 13.
    Grovas A, Fremgen A, Rauck A, et al. The National Cancer Data Base report on patterns of childhood cancers in the United States. Cancer. 1997;80(12):2321–32.CrossRefPubMedGoogle Scholar
  14. 14.
    Lange JR, Palis BE, Chang DC, et al. Melanoma in children and teenagers: an analysis of patients from the National Cancer Data Base. J Clin Oncol. 2007;25(11):1363–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Childrens Oncology Group Cure Search. 2009. Available at http://www.childrensoncologygroup.org/, Vol. January 19, 2009.
  16. 16.
    National Cancer Institute: SEER Surveillance Epidemiology and End Results. 2008. Available at www.seer.cancer.gov. Accessed April 22, 2010.
  17. 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. 18.
    National Cancer Registrars Association: Certification. 2008. Available at www.ncra-usa.org/. Accessed April 22, 2010.
  19. 19.
    Newman KD, Black T, Heller G, et al. Differentiated thyroid cancer: determinants of disease progression in patients < 21 years of age at diagnosis: a report from the Surgical Discipline Committee of the Children’s Cancer Group. Ann Surg. 1998;227(4):533–41.CrossRefPubMedGoogle Scholar
  20. 20.
    International Classification of Diseases for Oncology. 3rd ed. Geneva: World Helath Organization, 2000.Google Scholar
  21. 21.
    FORDS: Facility Oncolgy Registry Data Standards—Revised for 2007. Chicago, IL: Commision on Cancer, American College of Surgeons, 2007.Google Scholar
  22. 22.
    U.S. Census Bureau. 2008. Available at http://www.census.gov/main/www/cen2000.html. Accessed April 22, 2010.
  23. 23.
    Harness JK, Thompson NW, McLeod MK, et al. Differentiated thyroid carcinoma in children and adolescents. World J Surg 1992;16(4):547–53; discussion 553–4.CrossRefPubMedGoogle Scholar
  24. 24.
    Spinelli C, Bertocchini A, Antonelli A, Miccoli P. Surgical therapy of the thyroid papillary carcinoma in children: experience with 56 patients < or = 16 years old. J Pediatr Surg. 2004;39(10):1500–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Misiakos EP, Liakakos T, Macheras A, et al. Total thyroidectomy for the treatment of thyroid diseases in an endemic area. South Med J. 2006;99(11):1224–9.PubMedGoogle Scholar
  26. 26.
    Haveman JW, van Tol KM, Rouwe CW, et al. Surgical experience in children with differentiated thyroid carcinoma. Ann Surg Oncol. 2003;10(1):15–20.CrossRefPubMedGoogle Scholar
  27. 27.
    Shapiro NL, Bhattacharyya N. Population-based outcomes for pediatric thyroid carcinoma. Laryngoscope. 2005;115(2):337–40.CrossRefPubMedGoogle Scholar
  28. 28.
    Karakoc D, Erol T, Memmedova B, et al. Thyroid surgery: what has changed from (1970 to 2004): a Turkish perspective. Am J Surg. 2009;198(1):12–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Bilimoria KY, Bentrem DJ, Linn JG, et al. Utilization of total thyroidectomy for papillary thyroid cancer in the United States. Surgery. 2007;142(6):906–13.CrossRefPubMedGoogle Scholar
  30. 30.
    Hay ID, Thompson GB, Grant CS, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940-1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg. 2002;26(8):879–85.CrossRefPubMedGoogle Scholar
  31. 31.
    Liu JH, Zingmond DS, McGory ML, et al. Disparities in the utilization of high-volume hospitals for complex surgery. JAMA. 2006;296(16):1973–80.CrossRefPubMedGoogle Scholar
  32. 32.
    Rachmiel M, Charron M, Gupta A, et al. Evidence-based review of treatment and follow up of pediatric patients with differentiated thyroid carcinoma. J Pediatr Endocrinol Metab. 2006;19(12):1377–93.PubMedGoogle Scholar
  33. 33.
    Massimino M, Gasparini M, Ballerini E, Del Bo R. Primary thyroid carcinoma in children: a retrospective study of 20 patients. Med Pediatr Oncol. 1995;24(1):13–7.CrossRefPubMedGoogle Scholar
  34. 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
  35. 35.
    Zimmerman D, Hay ID, Gough IR, et al. 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(6):1157–66.PubMedGoogle Scholar
  36. 36.
    La Quaglia MP, Corbally MT, Heller G, et al. Recurrence and morbidity in differentiated thyroid carcinoma in children. Surgery. 1988;104(6):1149–56.PubMedGoogle Scholar
  37. 37.
    McHenry C, Smith M, Lawrence AM, et al. Nodular thyroid disease in children and adolescents: a high incidence of carcinoma. Am Surg. 1988;54(7):444–7.PubMedGoogle Scholar
  38. 38.
    Ceccarelli C, Pacini F, Lippi F, et al. Thyroid cancer in children and adolescents. Surgery. 1988;104(6):1143–8.PubMedGoogle Scholar
  39. 39.
    Halac I, Zimmerman D. Thyroid nodules and cancers in children. Endocrinol Metab Clin North Am. 2005;34(3):725–44, x.Google Scholar
  40. 40.
    Raab SS, Silverman JF, Elsheikh TM, et al. Pediatric thyroid nodules: disease demographics and clinical management as determined by fine needle aspiration biopsy. Pediatrics. 1995;95(1):46–9.PubMedGoogle Scholar
  41. 41.
    Hod N, Hagag P, Baumer M, et al. Differentiated thyroid carcinoma in children and young adults: evaluation of response to treatment. Clin Nucl Med. 2005;30(6):387–90.CrossRefPubMedGoogle Scholar
  42. 42.
    Welch Dinauer CA, Tuttle RM, Robie DK, et al. Clinical features associated with metastasis and recurrence of differentiated thyroid cancer in children, adolescents and young adults. Clin Endocrinol (Oxf). 1998;49(5):619–28.CrossRefGoogle Scholar
  43. 43.
    Parisi MT, Mankoff D. Differentiated pediatric thyroid cancer: correlates with adult disease, controversies in treatment. Semin Nucl Med. 2007;37(5):340–56.CrossRefPubMedGoogle Scholar
  44. 44.
    Dackiw AP, Zeiger M. Extent of surgery for differentiated thyroid cancer. Surg Clin North Am. 2004;84(3):817–32.CrossRefPubMedGoogle Scholar
  45. 45.
    Kebebew E, Clark OH. Differentiated thyroid cancer: “complete” rational approach. World J Surg. 2000;24(8):942–51.CrossRefPubMedGoogle Scholar
  46. 46.
    Jarzab B, Handkiewicz Junak D, Wloch J, et al. Multivariate analysis of prognostic factors for differentiated thyroid carcinoma in children. Eur J Nucl Med. 2000;27(7):833–41.CrossRefPubMedGoogle Scholar
  47. 47.
    Bargren AE, Meyer-Rochow GY, Delbridge LW, et al. Outcomes of surgically managed pediatric thyroid cancer. J Surg Res. 2009;156(1):70–3.CrossRefPubMedGoogle Scholar
  48. 48.
    Raval MV, Browne M, Chin AC, et al. Total thyroidectomy for benign disease in the pediatric patient–feasible and safe. J Pediatr Surg. 2009;44(8):1529–33.CrossRefPubMedGoogle Scholar
  49. 49.
    Filho JG, Kowalski LP. Postoperative complications of thyroidectomy for differentiated thyroid carcinoma. Am J Otolaryngol. 2004;25(4):225–30.CrossRefPubMedGoogle Scholar
  50. 50.
    Sosa JA, Bowman HM, Tielsch JM, et al. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg. 1998;228(3):320–30.CrossRefPubMedGoogle Scholar
  51. 51.
    Handkiewicz-Junak D, Wloch J, Roskosz J, et al. Total thyroidectomy and adjuvant radioiodine treatment independently decrease locoregional recurrence risk in childhood and adolescent differentiated thyroid cancer. J Nucl Med. 2007;48(6):879–88.CrossRefPubMedGoogle Scholar
  52. 52.
    Borson-Chazot F, Causeret S, Lifante JC, et al. Predictive factors for recurrence from a series of 74 children and adolescents with differentiated thyroid cancer. World J Surg. 2004;28(11):1088–92.CrossRefPubMedGoogle Scholar
  53. 53.
    DeGroot LJ, Kaplan EL, McCormick M, Straus FH. Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab. 1990;71(2):414–24.CrossRefPubMedGoogle Scholar
  54. 54.
    Bilimoria KY, Bentrem DJ, Ko CY, et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007;246(3):375–384.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Mehul V. Raval
    • 1
    • 2
    • 3
  • David J. Bentrem
    • 3
    • 4
  • Andrew K. Stewart
    • 1
  • Clifford Y. Ko
    • 1
    • 5
    • 6
  • Marleta Reynolds
    • 2
  1. 1.Division of Research and Optimal Patient Care, Cancer ProgramsAmerican College of SurgeonsChicagoUSA
  2. 2.Division of Pediatric SurgeryChildren’s Memorial HospitalChicagoUSA
  3. 3.Division of Gastrointestinal and Oncologic Surgery, Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoUSA
  4. 4.Jesse Brown VA Medical CenterChicagoUSA
  5. 5.Department of SurgeryUniversity of California Los AngelesLos AngelesUSA
  6. 6.VA Greater Los Angeles Healthcare SystemLos AngelesUSA

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