Comparison of pediatric and adult primary papillary thyroid cancer cases in the National Cancer Data Base

Abstract Context: Papillary thyroid cancer (PTC) patients <45 years old are considered to have an excellent prognosis; however, current guidelines recommend total thyroidectomy for PTC tumors >1.0 cm, regardless of age. Objective: Our objective was to examine the impact of extent of surgery on overall survival (OS) in patients <45 years old with stage I PTC of 1.1 to 4.0 cm. Design, Setting, and Patients: Adult patients <45 years of age undergoing surgery for stage I PTC were identified from the National Cancer Data Base (NCDB, 1998–2006) and the Surveillance, Epidemiology, and End Results dataset (SEER, 1988–2006). Main Outcome Measure: Multivariable modeling was used to compare OS for patients undergoing total thyroidectomy vs lobectomy. Results: In total, 29 522 patients in NCDB (3151 lobectomy, 26 371 total thyroidectomy) and 13 510 in SEER (1379 lobectomy, 12 131 total thyroidectomy) were included. Compared with patients undergoing lobectomy, patients having total thyroidectomy more often had extrathyroidal and lymph node disease. At 14 years, unadjusted OS was equivalent between total thyroidectomy and lobectomy in both databases. After adjustment, OS was similar for total thyroidectomy compared with lobectomy across all patients with tumors of 1.1 to 4.0 cm (NCDB: hazard ratio = 1.45 [confidence interval = 0.88–2.51], P = 0.19; SEER: 0.95 (0.70–1.29), P = 0.75) and when stratified by tumor size: 1.1 to 2.0 cm (NCDB: 1.12 [0.50–2.51], P = 0.78; SEER: 0.95 [0.56–1.62], P = 0.86) and 2.1 to 4.0 cm (NCDB: 1.93 [0.88–4.23], P = 0.10; SEER: 0.94 [0.60–1.49], P = 0.80). Conclusions: After adjusting for patient and clinical characteristics, total thyroidectomy compared with thyroid lobectomy was not associated with improved survival for patients <45 years of age with stage I PTC of 1.1 to 4.0 cm. Additional clinical and pathologic factors should be considered when choosing extent of resection.

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National Cancer Data Base Shows National Gap in Use of Total Thyroidectomy for Treating Thyroid Cancer in Children

Oncology Times ◽

10.1097/01.cot.0000392696.73391.13 ◽

2010 ◽

Vol 32 (23) ◽

pp. 12

Author(s):

&NA;

Keyword(s):

Thyroid Cancer ◽

Total Thyroidectomy ◽

Data Base ◽

National Cancer Data Base ◽

Cancer Data ◽

Cancer In Children

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Relationship Between Radiation Therapy Dose and Overall Survival in Anaplastic Thyroid Cancer: Analysis of the National Cancer Data Base

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2016.06.1538 ◽

2016 ◽

Vol 96 (2) ◽

pp. E361

Author(s):

T.A. Pezzi ◽

A.S.R. Mohamed ◽

T. Sheu ◽

P. Blanchard ◽

V.C. Sandulache ◽

...

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Thyroid Cancer ◽

Data Base ◽

Anaplastic Thyroid Cancer ◽

National Cancer Data Base ◽

Cancer Data

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Lymphovascular invasion is associated with survival for papillary thyroid cancer

Endocrine Related Cancer ◽

10.1530/erc-16-0123 ◽

2016 ◽

Vol 23 (7) ◽

pp. 555-562 ◽

Cited By ~ 12

Author(s):

Lauren N Pontius ◽

Linda M Youngwirth ◽

Samantha M Thomas ◽

Randall P Scheri ◽

Sanziana A Roman ◽

...

Keyword(s):

Thyroid Cancer ◽

Lymph Nodes ◽

Papillary Thyroid Cancer ◽

Lymphovascular Invasion ◽

Distant Metastases ◽

Cox Proportional Hazards Model ◽

Papillary Thyroid ◽

Metastatic Lymph Nodes ◽

Cancer Data ◽

Metastatic Lymph

Data are limited regarding the association between tumor lymphovascular invasion and survival for patients with papillary thyroid cancer (PTC). This study sought to examine lymphovascular invasion as an independent prognostic factor for patients with PTC undergoing thyroid resection. The National Cancer Data Base (2010–2011) was queried for patients with PTC who underwent total thyroidectomy or lobectomy. Patients were classified into two groups based on the presence/absence of lymphovascular invasion. Demographic, clinical and pathological features were evaluated for all patients. A Cox proportional hazards model was utilized to identify factors associated with survival. Results show that 45,415 patients met inclusion criteria; 11.6% had lymphovascular invasion. Patients with lymphovascular invasion were more likely to have larger tumors (2.8cm vs 1.5cm,P<0.01), metastatic lymph nodes (74.1% vs 32.5%,P<0.01), and distant metastases (3.0% vs 0.5%,P<0.01). They were also more likely to receive radioactive iodine (69.3% vs 44.9%,P<0.01). Unadjusted overall 5-year survival was lower for patients who had tumors with lymphovascular invasion (86.6% vs 94.5%) (log-rankP<0.01). After adjustment, increasing patient age (HR=1.06,P<0.01), male gender (HR=1.68,P<0.01), presence of metastatic lymph nodes (HR=1.77,P<0.01), distant metastases (HR=3.49,P<0.01), and lymphovascular invasion (HR=1.88,P<0.01) were associated with compromised survival. For patients with lymphovascular invasion, treatment with RAI was associated with reduced mortality (HR=0.43,P<0.01). The presence of lymphovascular invasion among patients with PTC is independently associated with compromised survival. Patients who have PTC with lymphovascular invasion should be considered higher risk, and adjuvant RAI should be more strongly considered.

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