Comprehensive clinical assessment of 740 cases of surgically treated thyroid cancer in children of Belarus.
OBJECTIVE
A retrospective study was designed to evaluate the results of surgical treatment and follow-up data in thyroid cancer patients less than 15 years old at the time of surgery.


BACKGROUND
Pediatric thyroid carcinomas have a high rate of lymph nodal and distant metastases. Risk factors for recurrences and postoperative morbidity have not been assessed yet in a representative series.


METHODS
The group included 740 pediatric patients with thyroid cancer. Total thyroidectomy was performed in 426 (57.6%), lobectomy in 248 (33.5%), subtotal thyroidectomy in 58 (7.8%) cases, and 8 patients (1.1%) underwent partial lobectomy.


RESULTS
The mean follow-up period was 115.8 months (range, 1.5-236.4 months). Recurrence was diagnosed in 204 cases (27.6%), including 73 local relapses (9.9%), 90 distant metastases (12.2%), and a combination of local and distant recurrences in 41 (5.5%) patients. Multivariate statistical assessment revealed the following independent parameters significantly associated with the risk of recurrent nodal disease: a young age at diagnosis, multifocal carcinomas, N1 status, and lack of neck lymph node dissection. For lung metastases, the significant risk factors were female gender, young age at diagnosis, and presence of symptoms. The observed 5- and 10-year survival for the entire group was 99.5% and 98.8%, respectively. Postoperative hypoparathyroidism was significantly associated with multifocal tumors, central compartment removal, and ipsilateral dissection.


CONCLUSIONS
Total thyroidectomy followed by radioiodine therapy is an optimal treatment strategy that makes it possible to achieve a cure in a vast majority of pediatric patients with differentiated thyroid carcinomas. Risk of recurrence is strongly associated with tumor stage, extent of surgery, the young patient's age, and presence of symptoms at diagnosis.
Demidchik
Yuri E
YE
Department for Oncology, Belarusian State Medical University, Minsk, Belarus.
Demidchik
Eugene P
EP
Reiners
Christoph
C
Biko
Johannes
J
Mine
Mariko
M
Saenko
Vladimir A
VA
Yamashita
Shunichi
S
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007011:Hypoparathyroidism / Q000453:epidemiology; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D016015:Logistic Models; D008175:Lung Neoplasms / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D002094:Republic of Belarus; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy; D014826:Vocal Cord Paralysis / Q000453:epidemiology
D007457:Iodine Radioisotopes