title: A National Perspective of the Risk, Presentation, and Outcomes of Pediatric Thyroid Cancer.
abstract: Thyroid cancer is the most common endocrine malignant neoplasm in children and adolescents. Despite a more advanced presentation of thyroid cancer, younger patients tend to have a more favorable prognosis and a lower mortality rate than adults with thyroid cancer.
  
  
  
  To examine the presentation and outcomes of thyroid cancer in pediatric patients.
  
  
  
  A cross-sectional weighted analysis was performed using data from the Nationwide Inpatient Sample from January 1, 2003, to December 31, 2010. Patient data were derived from a sample of 20% of community hospitals in the United States. Six hundred forty-four children and adolescents (age, <18 years; hereinafter referred to as children) with thyroid cancer were compared with 43 536 adults (age, ≥18 years) with thyroid cancer. Data were analyzed from December 7, 2014, to November 19, 2015.
  
  
  
  Thyroid cancer and thyroidectomy.
  
  
  
  Presentation and management characteristics of thyroid cancer and thyroidectomy outcomes in relation to surgeon volume and specialty.
  
  
  
  A total of 644 cases of pediatric thyroid cancer were included (female, 77.3%; mean [SEM] age, 13.8 [0.2] years), corresponding to a weighted sample of 32 563. Compared with adults with thyroid cancer, children were more likely to present with cervical lymph node involvement (31.5% vs 14.7%; odds ratio [OR], 2.29; 95% CI, 1.76-2.97; P < .001) and lung metastases (5.7% vs 2.2%; OR, 2.79; 95% CI, 1.82-4.28; P < .001), whereas bone metastases were more frequent in adults (0.3% vs 1.1%; OR, 0.23; 95% CI, 0.06-0.90; P = .04). Children were more likely to be treated by a low-volume surgeon (26.9% vs 16.0%; OR, 2.09; 95% CI, 1.26-3.48; P = .005) or a pediatric surgeon (14.5% vs 9.6%; OR, 1.66; 95% CI, 1.04-2.67; P = .04) and in a low-volume hospital (20.5% vs 15.2%; OR, 2.97; 95% CI, 1.60-5.54; P < .001) or a teaching hospital (81.7% vs 63.1%; OR, 3.61; 95% CI, 2.33-5.60; P < .001). Compared with those treated by low-volume surgeons, children treated by high-volume surgeons were less likely to experience postoperative complications (14.3% vs 35.9%; OR, 0.16; 95% CI, 0.05-0.51; P = .002) or a hospital stay of more than 1 day (49.8% vs 67.9%; OR, 0.36; 95% CI, 0.15-0.90; P = .03). Management by pediatric surgeons did not significantly alter the risk for postoperative complications compared with other specialties (21.3% vs 18.5%; OR, 1.71; 95% CI, 0.64-4.53, P = .28). Management of thyroid cancer in children was significantly more costly (>$10 067.08/case) compared with adults (P = .04).
  
  
  
  Compared with thyroid cancer in adults, pediatric thyroid cancer is more likely to present as advanced disease and to be managed by low-volume or pediatric surgeons. In addition, within the United States, surgeon volume appears to be more crucial in determining thyroidectomy outcomes than the surgeon's field of specialization.
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Al-Qurayshi
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Adam
authors.initials: A
authors.lastname: Hauch
authors.affiliation: Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Sudesh
authors.initials: S
authors.lastname: Srivastav
authors.affiliation: Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Aslam
authors.affiliation: Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Paul
authors.initials: P
authors.lastname: Friedlander
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000556:secondary; D002648:Child; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000556:secondary; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology* / Q000601:surgery; D013965:Thyroidectomy / Q000191:economics; D014481:United States / Q000453:epidemiology