Treatment strategy of papillary thyroid carcinoma in children and adolescents: clinical significance of the initial nodal manifestation.
BACKGROUND
Risk factors and treatment strategy in younger patients with papillary thyroid carcinoma are still controversial.


METHODS
We reviewed 120 consecutive papillary thyroid carcinoma patients younger than 20 years who underwent initial surgery between 1977 and 2004 (14 male and 106 female subjects; mean age, 16.3 years; mean follow-up, 11.6 years). Outcomes were evaluated initially, and risk factors for disease-free survival (DFS) were analyzed statistically. Cox proportional multivariate analysis revealed that initial nodal manifestation (P < .001, hazard ratio 2.97) was the most statistically significant risk factor for DFS. The outcomes were then compared between four subgroups on the basis of the initial nodal manifestation and node dissection: 17 patients in group A (no lymphadenopathy, no or only prophylactic central dissection), 30 patients in group B (no lymphadenopathy, prophylactic modified neck dissection, MND), 46 patients in group C (nonpalpable lymphadenopathy detected by radiological or operative findings, therapeutic MND), and 27 patients in group D (palpable lymphadenopathy, therapeutic MND).


RESULTS
Subtotal/total thyroidectomy and radioactive iodine therapy were performed for 47.1 and 0% in group A, 33.3 and 0% in group B, 43.4 and 10.9% in group C, and 85.1 and 48.1% in group D, respectively. In groups A, B, C, and D, 0%, 3.3%, 28.3%, and 48.1% developed recurrence, respectively (P < .001). DFS Kaplan-Meier curves differed significantly among the four subgroups (P < .0005).


CONCLUSIONS
Initial nodal manifestation is useful to predict DFS in younger papillary thyroid carcinoma patients. Our findings will be beneficial to determine the treatment strategy. Conservative therapy is considered acceptable for patients without risk factors.
Wada
Nobuyuki
N
Surgical Branch, Ito Hospital, Tokyo, Japan. Wadan523@aol.com
Sugino
Kiminori
K
Mimura
Takashi
T
Nagahama
Mitsuji
M
Kitagawa
Wataru
W
Shibuya
Hiroshi
H
Ohkuwa
Keiko
K
Nakayama
Hirotaka
H
Hirakawa
Shohei
S
Yukawa
Norio
N
Rino
Yasushi
Y
Masuda
Munetaka
M
Ito
Koichi
K
D000293:Adolescent; D000328:Adult; D002291:Carcinoma, Papillary / Q000556:secondary / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D037981:Neck Dissection; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome; D055815:Young Adult