Section of Endocrine Surgery, Columbia University Irving Medical Center, New York, New York; Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Section of Endocrine Surgery, Columbia University Irving Medical Center, New York, New York.
J Surg Res. 2021 Jul;263:207-214. doi: 10.1016/j.jss.2021.01.043. Epub 2021 Mar 6.
Childhood papillary thyroid cancer is more aggressive than carcinomas in adults. Current American Thyroid Association pediatric guidelines recommend a total or near-total thyroidectomy for all pediatric patients without gross evidence of lymph node metastases. Our objective is to analyze trends in the surgical management of pediatric papillary thyroid cancer and assess how well the guidelines are implemented.
A retrospective cohort study of pediatric patients (ages 19 y and under) who underwent a thyroidectomy was conducted using the Surveillance, Epidemiology, and End Results database 2006-2017. Procedure type was classified as lobectomy or less and subtotal or total thyroidectomy. Descriptive statistics to illustrate patient and tumor characteristics as well as chi-square analysis to evaluate frequency of treatment with total thyroidectomies versus lobectomy or less were performed. Logistic regression analysis controlling for age, sex, size of tumor, rural versus urban institutions, and surgery year was conducted to identify factors predictive of procedure type.
A total of 2271 children underwent surgical management of papillary thyroid cancer between 2006 and 2017. Most patients received a subtotal or total thyroidectomy as surgical management (n = 2,085, 91.8%). One hundred eighty-six patients (8.2%) received a lobectomy or less. The number of lobectomies or less increased with time, with 41 (6.6%) patients between 2006 and 2009, 98 (8.0%) between 2009 and 2015, and 47 (11.1%) between 2016 and 2017 (P = 0.03). Mortality rates were low (n = 15, 0.7%). On logistic regression analysis, later stages, larger sizes, and earlier operative years were predictive of a near-total or total thyroidectomy.
Despite the American Thyroid Association Guidelines recommending a total thyroidectomy for pediatric well-differentiated thyroid cancer, the results of this study demonstrate that thyroid lobectomies are being performed in increasing frequency for smaller tumors in earlier stages of disease. Further investigation of whether this trend actually affects the outcomes in this patient cohort is needed.
儿童甲状腺乳头状癌比成人的更具侵袭性。目前，美国甲状腺协会儿科指南建议对所有无明显淋巴结转移的儿科患者进行全甲状腺或近全甲状腺切除术。我们的目的是分析儿科甲状腺乳头状癌手术治疗的趋势，并评估指南的实施情况。
利用 2006-2017 年监测、流行病学和最终结果数据库，对接受甲状腺切除术的儿童（19 岁及以下）进行了回顾性队列研究。手术类型分为叶切除术或更少，以及次全或全甲状腺切除术。进行描述性统计，说明患者和肿瘤特征，并进行卡方分析，以评估全甲状腺切除术与叶切除术或更少的治疗频率。进行逻辑回归分析，控制年龄、性别、肿瘤大小、城乡机构和手术年份，以确定预测手术类型的因素。
2006 年至 2017 年间，共有 2271 名儿童接受了甲状腺乳头状癌的手术治疗。大多数患者接受了次全或全甲状腺切除术作为手术治疗（n=2085，91.8%）。186 名患者（8.2%）接受了叶切除术或更少。随着时间的推移，叶切除术或更少的数量增加，2006 年至 2009 年有 41 例（6.6%），2009 年至 2015 年有 98 例（8.0%），2016 年至 2017 年有 47 例（11.1%）（P=0.03）。死亡率较低（n=15，0.7%）。逻辑回归分析表明，晚期、较大的肿瘤和早期手术年份与近全或全甲状腺切除术相关。
尽管美国甲状腺协会指南建议对儿童分化型甲状腺癌进行全甲状腺切除术，但本研究结果表明，对于疾病早期较小的肿瘤，甲状腺叶切除术的应用频率正在增加。需要进一步研究这种趋势是否会影响该患者队列的结果。
