title: Pediatric differentiated thyroid carcinoma in stage I: risk factor analysis for disease free survival.
abstract: BACKGROUND
  To examine the outcomes and risk factors in pediatric differentiated thyroid carcinoma (DTC) patients who were defined as TNM stage I because some patients develop disease recurrence but treatment strategy for such stage I pediatric patients is still controversial.
  
  
  METHODS
  We reviewed 57 consecutive TNM stage I patients (15 years or less) with DTC (46 papillary and 11 follicular) who underwent initial treatment at Ito Hospital between 1962 and 2004 (7 males and 50 females; mean age: 13.1 years; mean follow-up: 17.4 years). Clinicopathological results were evaluated in all patients. Multivariate analysis was performed to reveal the risk factors for disease-free survival (DFS) in these 57 patients.
  
  
  RESULTS
  Extrathyroid extension and clinical lymphadenopathy at diagnosis were found in 7 and 12 patients, respectively. Subtotal/total thyroidectomy was performed in 23 patients, modified neck dissection in 38, and radioactive iodine therapy in 10. Pathological node metastasis was confirmed in 37 patients (64.9%). Fifteen patients (26.3%) exhibited local recurrence and 3 of them also developed metachronous lung metastasis. Ten of these 15 achieved disease-free after further treatments and no patients died of disease. In multivariate analysis, male gender (p = 0.017), advanced tumor (T3, 4a) stage (p = 0.029), and clinical lymphadenopathy (p = 0.006) were risk factors for DFS in stage I pediatric patients.
  
  
  CONCLUSIONS
  Male gender, tumor stage, and lymphadenopathy are risk factors for DFS in stage I pediatric DTC patients. Aggressive treatment (total thyroidectomy, node dissection, and RI therapy) is considered appropriate for patients with risk factors, whereas conservative or stepwise approach may be acceptable for other patients.
authors.affiliation: Surgical Branch, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo 150-8308, Japan. wadan523@aol.com
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Wada
authors.forename: Kiminori
authors.initials: K
authors.lastname: Sugino
authors.forename: Takashi
authors.initials: T
authors.lastname: Mimura
authors.forename: Mitsuji
authors.initials: M
authors.lastname: Nagahama
authors.forename: Wataru
authors.initials: W
authors.lastname: Kitagawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shibuya
authors.forename: Keiko
authors.initials: K
authors.lastname: Ohkuwa
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Nakayama
authors.forename: Shohei
authors.initials: S
authors.lastname: Hirakawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Rino
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
authors.forename: Koichi
authors.initials: K
authors.lastname: Ito
mesh_terms: D000293:Adolescent; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D010372:Pediatrics; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome