Total Thyroidectomy vs Thyroid Lobectomy for Localized Papillary Thyroid Cancer in Children: A Propensity-Matched Survival Analysis - 23/06/21

Doi : 10.1016/j.jamcollsurg.2021.03.025

Kelvin Memeh, MD, MRCS ^a,^⁎ , Brian Ruhle, MD, MS ^a, Salman Alsafran, MD, MS ^b, Tanaz Vaghaiwalla, MD, MS ^a, Edwin Kaplan, MD, FACS ^a, Peter Angelos, MD, PhD, FACS ^a, Xavier M. Keutgen, MD, FACS ^a
^a Section of Endocrine Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL
^b Faculty of Medicine, Kuwait University Health Science Center, Kuwait

^∗Correspondence address: Kelvin Memeh, MD, MRCS, Section of Endocrine Surgery, Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Ave, Room G-201, MC4052, Chicago, IL 60637.Section of Endocrine SurgeryDepartment of SurgeryUniversity of Chicago Medicine5841 S. Maryland AveRoom G-201MC4052ChicagoIL60637

Abstract

Background

Current guidelines recommend total thyroidectomy (TT) and radioablation for most papillary thyroid cancer (PTC) in children. These guidelines have been criticized as aggressive, especially for early-stage PTC, as it likely does not influence patient survival and results in life-long thyroid hormone replacement. We sought to study whether the extent of thyroidectomy (TT vs thyroid lobectomy [TL]) influences overall and disease-specific survival in children with localized PTC.

Methods

The National Cancer Database and the Surveillance, Epidemiology, and End Results registries were queried. Patients 18 years or younger with low-risk PTC between 2004 and 2016 were included. Using a 1:1 propensity score matching, patients who underwent TT were matched for age, sex, race, year of diagnosis, and tumor size with a similar cohort of patients who underwent TL. Primary end points were overall survival and disease-specific survival.

Results

There were 3,500 patients identified as surgically treated for PTC, of which 1,325 patients met inclusion criteria for matching. Three hundred and twenty-six patients were matched. One hundred and sixty-three patients had TT; 140 were female and mean age was 16 years (interquartile range [IQR] 13 to 17 years). One hundred and sixty-three patients had TL; 140 were female and mean age was 16 years (IQR 14 to 17 years). Median follow-up was 5.0 years (IQR 2.8 to 8 years) and 8.3 years (IQR 3.6 to 14.4 years) in the National Cancer Database and Surveillance, Epidemiology, and End Results cohorts, respectively. There was no statistically significant difference in overall survival or disease-specific survival in patients with PTC < 4 cm, regardless of whether patients underwent TT or TL (p = 0.32 for National Cancer Database registry and p = 0.67 for Surveillance, Epidemiology, and End Results registry).

Conclusions

This study suggests that the extent of thyroidectomy does not influence survival for pediatric patients with early-stage PTC and that TL might be adequate in this patient population.

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Abbreviations and Acronyms : DTC, ETE, IQR, NCDB, PS, PTC, RAI, SEER

Plan

Baseline characteristics and matching

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	Disclosure Information: Authors have nothing to disclose. Timothy J Eberlein, Editor-in-Chief, has nothing to disclose. Ronald J Weigel, CME Editor, has nothing to disclose.