Predictors of nodal metastasis in pediatric differentiated thyroid cancer.
OBJECTIVE
There are limited data identifying risk factors for nodal metastasis in children with differentiated thyroid cancer.


METHODS
The 1998-2011 Surveillance, Epidemiology, and End Results Program database was queried for patients ≤18years of age diagnosed with differentiated thyroid cancer who underwent nodal examination. Patients were grouped by absence or presence of nodal metastasis. Multivariable logistic regression methods were used to identify independent risk factors for nodal metastasis.


RESULTS
In total, 1075 children met study criteria: 734 (68%) had nodal metastases, while 341 (32%) did not. After adjustment, risk factors for nodal metastasis included larger tumor size (1.1-2cm: odds ratio [OR] 2.02, 95% confidence interval [CI] 1.22-3.34, p=0.006; 2.1-4cm: OR 3.37, 95% CI 2.03-5.60, p<0.001; > 4cm: OR 3.39, 95% CI 1.69-6.81, p=0.001), extrathyroidal extension (OR 7.28, 95% CI 4.07-13.01, p<0.001), and multifocal disease (OR 1.94, 95% CI 1.33-2.84, p=0.001).


CONCLUSIONS
Increasing tumor size, extrathyroidal extension, and multifocal disease are independent factors associated with nodal metastases in pediatric differentiated thyroid cancer. If these risk factors are present, children with differentiated thyroid cancer should undergo careful preoperative evaluation for evidence of lateral cervical lymph node metastases, and the central compartment should be evaluated intraoperatively, with consideration of central lymphadenectomy.


METHODS
Level III.
Duke University Department of Surgery. Electronic address: jina.kim1@dm.duke.edu.
Jina
J
Kim
Duke University Department of Surgery.
Zhifei
Z
Sun
Duke University Department of Surgery.
Mohamed A
MA
Adam
Duke University Division of Pediatric Surgery.
Obinna O
OO
Adibe
Duke University Division of Pediatric Surgery.
Henry E
HE
Rice
Duke University Division of Advanced Oncologic and GI Surgery.
Sanziana A
SA
Roman
Duke University Division of Pediatric Surgery.
Elisabeth T
ET
Tracy
D000293:Adolescent; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy
Lymph node metastasis; Pediatric thyroid cancer; Thyroid neoplasms