title: Pediatric papillary thyroid cancer >1 cm: is total thyroidectomy necessary?
abstract: OBJECTIVE
  Treatment of pediatric papillary thyroid cancer (p-PTC) often follows adult guidelines, including total thyroidectomy for tumors >1cm. This study examined the association between operation type and overall survival (OS) for tumors >1cm in size in the pediatric population.
  
  
  METHODS
  Patients ≤ 21 years of age with primary papillary thyroid cancer >1cm were reviewed from the National Cancer Data Base (NCDB) from 1998 to 2011. Kaplan-Meier analysis followed by Cox proportional hazard models estimated the impact of total thyroidectomy (TT) vs. partial thyroidectomy (PT) on overall survival. Models were adjusted for patient, tumor, and treatment factors.
  
  
  RESULTS
  3,861 cases (3474 TT, 387 PT) were included. Estimated 15-year overall survival was 96.10% after TT and 96.18% after PT (p=0.0855). In multivariate analysis of 3173 patients, only lowest socioeconomic level (HR 4.93, p=0.001) and unfavorable histology (HR 6.11, p=0.016) were associated with worse OS. Survival for patients undergoing TT was not statistically improved over those undergoing PT (HR 0.81, p=0.694).
  
  
  CONCLUSIONS
  p-PTC >1cm has an excellent 15-year overall survival. Treatment with TT did not have an improved OS compared to PT. Lower socioeconomic status and unfavorable histology were associated with decreased OS.
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Children's Hospital of Alabama, Birmingham, AL. Electronic address: Tate.Nice@childrensal.org.
authors.forename: Tate
authors.initials: T
authors.lastname: Nice
authors.affiliation: School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Pasara
authors.affiliation: Department of Surgery, John Wayne Cancer Institute/Providence St. John's Medical Center, Santa Monica, CA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Goldfarb
authors.affiliation: Department of Surgery/Pediatric Surgery Division, University of Texas Health Science Center, San Rosa Children's Hospital, San Antonio, TX.
authors.forename: John
authors.initials: J
authors.lastname: Doski
authors.affiliation: Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA.
authors.forename: Adam
authors.initials: A
authors.lastname: Goldin
authors.affiliation: Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Gow
authors.affiliation: Division of Pediatric Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Jed G
authors.initials: JG
authors.lastname: Nuchtern
authors.affiliation: Division of Pediatric Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Sanjeev A
authors.initials: SA
authors.lastname: Vasudevan
authors.affiliation: Division of Pediatric Surgery, Maine Medical Center, Portland, ME.
authors.forename: Monica
authors.initials: M
authors.lastname: Langer
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Children's Hospital of Alabama, Birmingham, AL.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Beierle
mesh_terms: D000293:Adolescent; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Papillary thyroid cancer; Pediatric; Thyroidectomy