Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
JAMA Otolaryngol Head Neck Surg. 2016 May 1;142(5):472-8. doi: 10.1001/jamaoto.2016.0104.
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.
DESIGN, SETTING, AND PARTICIPANTS: 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.
甲状腺癌是儿童和青少年中最常见的内分泌恶性肿瘤。尽管甲状腺癌的表现更为晚期，但年轻患者的预后往往比成人甲状腺癌患者更为有利，死亡率也更低。
研究儿童甲状腺癌的表现和结局。
设计、地点和参与者：使用美国全国住院患者样本 2003 年 1 月 1 日至 2010 年 12 月 31 日的数据进行了一项横断面加权分析。患者数据来自美国社区医院的样本，占 20%。644 名儿童和青少年（年龄，<18 岁；以下简称儿童）患有甲状腺癌，与 43536 名患有甲状腺癌的成年人（年龄，≥18 岁）进行了比较。数据分析于 2014 年 12 月 7 日至 2015 年 11 月 19 日进行。
甲状腺癌和甲状腺切除术。
与外科医生的手术量和专业领域相关的甲状腺癌的表现和管理特征以及甲状腺切除术的结果。
共纳入 644 例儿童甲状腺癌病例（女性，77.3%；平均[SEM]年龄，13.8[0.2]岁），对应的加权样本为 32563 例。与成人甲状腺癌患者相比，儿童更有可能出现颈部淋巴结受累（31.5%比 14.7%；优势比[OR]，2.29；95%置信区间[CI]，1.76-2.97；P<0.001）和肺转移（5.7%比 2.2%；OR，2.79；95%CI，1.82-4.28；P<0.001），而骨转移在成人中更为常见（0.3%比 1.1%；OR，0.23；95%CI，0.06-0.90；P=0.04）。儿童更有可能由低手术量的外科医生（26.9%比 16.0%；OR，2.09；95%CI，1.26-3.48；P=0.005）或儿科外科医生（14.5%比 9.6%；OR，1.66；95%CI，1.04-2.67；P=0.04）治疗，并且在低手术量医院（20.5%比 15.2%；OR，2.97；95%CI，1.60-5.54；P<0.001）或教学医院（81.7%比 63.1%；OR，3.61；95%CI，2.33-5.60；P<0.001）接受治疗。与由低手术量外科医生治疗的儿童相比，由高手术量外科医生治疗的儿童术后并发症的发生率较低（14.3%比 35.9%；OR，0.16；95%CI，0.05-0.51；P=0.002）或住院时间超过 1 天的发生率较低（49.8%比 67.9%；OR，0.36；95%CI，0.15-0.90；P=0.03）。与其他专业相比，儿科外科医生的治疗并没有显著改变术后并发症的风险（21.3%比 18.5%；OR，1.71；95%CI，0.64-4.53，P=0.28）。儿童甲状腺癌的治疗费用明显高于成人（>$10067.08/例）（P=0.04）。
与成人甲状腺癌相比，儿童甲状腺癌更有可能表现为晚期疾病，并且由低手术量或儿科外科医生进行治疗。此外，在美国，外科医生的手术量似乎比外科医生的专业领域更能决定甲状腺切除术的结果。
