World Journal of Surgery

, Volume 28, Issue 11, pp 1088–1092

Predictive Factors for Recurrence from a Series of 74 Children and Adolescents with Differentiated Thyroid Cancer

  • Francoise Borson-Chazot
  • Sylvain Causeret
  • Jean-Christophe Lifante
  • Marylin Augros
  • Nicole Berger
  • Jean-Louis Peix
Article

Abstract

The influence of clinical and treatment factors on the risk of recurrence was analyzed from a retrospective series of 74 children and adolescents with thyroid cancer (55 girls, 19 boys; age 2–20 years). Two groups, comparable in terms of age, sex, and previous radiotherapy, were compared according to the presence (group 1) or absence (group 2) of cervical lymph nodes identified by palpation or ultrasonography. Total thyroidectomy (TT) with lymph node dissection (LND) was performed in the 19 group 1 patients, whereas in group 2 patients (n = 55) lobectomy was performed in 29, TT in 26, and LND in 7. Pathology studies showed papillary thyroid carcinoma in 95% of cases. In group 1, tumors were more frequently multifocal (89% vs. 16% in group 2), invasive with extension beyond the thyroid capsule (68% vs. 5% in group 2), and of the diffuse sclerosing variety (63% vs. 4% in group 2) (p < 0.001). With a median follow-up of 61 months, lymph node recurrence was seen in 53% of group 1 patients and in no patients in group 2. Three group 2 patients (10%) were reoperated for a local recurrence after lobectomy. Risk factors for reintervention were young age (< 15 years) (p < 0.01) and cervical lymph nodes (p < 0.001). Survivals without reintervention at 5 and 10 years were, respectively, 58% and 38% for group 1 and 94% and 90% for group 2 (p < 0.001). At the time of analysis, 68% of group 1 patients and 98% of group 2 patients were in remission. In conclusion, the presence of palpable cervical lymph nodes at diagnosis is associated with more invasive forms of malignancy and is a predictive factor of recurrence regardless of the extent of the initial surgery.

References

  1. 1.
    Hung, W, Sarlis, NJ 2002Current controversies in the management of pediatric patients with well-differentiated nonmedullary thyroid cancer: a reviewThyroid12683702CrossRefPubMedGoogle Scholar
  2. 2.
    Harash, HR, William, ED 1995Childhood thyroid cancer in England and WalesBr. J. Cancer72777783PubMedGoogle Scholar
  3. 3.
    Bucsky, P, Parlowsky, T 1997Epidemiology and therapy of thyroid cancer in childhood and adolescenceExp. Clin. Endocrinol. Diabetes1057073Google Scholar
  4. 4.
    Feinmesser, R, Lubin, E, Segal, K,  et al. 1997Carcinoma of the thyroid in children: a reviewJ. Pediatr. Endocrinol. Metab.10561568PubMedGoogle Scholar
  5. 5.
    Schlumberger, M, Vathaire, F, Travagli, JP,  et al. 1987Differentiated thyroid carcinoma in childhood: long term follow-up of 72 patientsJ. Clin. Endocrinol. Metab.6510881094PubMedGoogle Scholar
  6. 6.
    Farahati, J, Bucsky, P, Parlowsky, T,  et al. 1997Characteristics of differentiated thyroid carcinoma in children and adolescents with respect to age, gender and histologyCancer8021562162CrossRefPubMedGoogle Scholar
  7. 7.
    Quaglia, MP, Black, T, Holcomb, GW,  et al. 2000Differentiated cancer: clinical characteristics treatment and outcome in patients under 21 years of age who present with distant metastases; a report from the Surgical Discipline Committee of the Children’s Cancer GroupJ. Pediatr. Surg.35955959CrossRefPubMedGoogle Scholar
  8. 8.
    Grigsby, PW, Gal-or, A, Michalsky, JM,  et al. 2002Childhood and adolescent thyroid carcinomaCancer95724729CrossRefPubMedGoogle Scholar
  9. 9.
    Welch Dinauer, CA, Tuttle, RM, Robie, DK,  et al. 1998Clinical features associated with metastasis and recurrence of differentiated thyroid cancer in children, adolescents and young adultsClin. Endocrinol. (Oxf.)49619628CrossRefGoogle Scholar
  10. 10.
    Vassilopoulou-Sellin, R, Goepfert, H, Raney, B,  et al. 1998Differentiated thyroid cancer in children and adolescents: clinical outcome and mortality after long term follow-upHead Neck20549555CrossRefPubMedGoogle Scholar
  11. 11.
    Samuel, AM, Rajashekharrao, B, Shah, DH 1998Pulmonary metastases in children and adolescents with well-differentiated thyroid cancerJ. Nucl. Med.3915311536PubMedGoogle Scholar
  12. 12.
    Brink, JS, Heerden, JA, McIver, B,  et al. 2000Papillary thyroid cancer with pulmonary metastases in children: long term prognosisSurgery128881886CrossRefPubMedGoogle Scholar
  13. 13.
    Beasley, NJ, Lee, J, Eski, S,  et al. 2002Impact of nodal metastases on prognosis in patients with well differentiated thyroid cancerArch. Otolaryngol. Head Neck Surg.128825828PubMedGoogle Scholar
  14. 14.
    Newman, KD, Black, T, Heller, G,  et al. 1998Differentiated thyroid cancer: determinants of disease progression in patients < 21 years of age at diagnosis: a report from the Surgical Discipline Committee of the Children’s Cancer GroupAnn. Surg.227533541CrossRefPubMedGoogle Scholar
  15. 15.
    Alessandri, AJ, Goddard, KJ, Blair, GK,  et al. 2000Age is the major determinant of recurrence in pediatric differentiated thyroid carcinomaMed. Pediatr. Oncol.534146CrossRefGoogle Scholar
  16. 16.
    Arici, C, Erdogan, O, Altunbas, H,  et al. 2002Differentiated thyroid cancer in children and adolescents: clinical characteristics, treatment and outcome of 15 patientsHorm. Res.57153156CrossRefPubMedGoogle Scholar
  17. 17.
    Giuffreda, D, Scollo, C, Pellegretti, G,  et al. 2002Differentiated thyroid cancer in children and adolescentsJ. Endocrinol. Invest.251824PubMedGoogle Scholar
  18. 18.
    Hallwirth, U, Flores, J, Kaserer, K,  et al. 1999Differentiated thyroid cancer in children and adolescents: the importance of adequate surgery and review of the literatureEur. J. Pediatr. Surg.9359363PubMedGoogle Scholar
  19. 19.
    Welch Dinauer, CA, Tuttle, M, Robie, DK,  et al. 1999Extensive surgery improves recurrence-free survival for children and young patients with class I papillary thyroid carcinomaJ. Pediatr. Surg.3417991804CrossRefPubMedGoogle Scholar
  20. 20.
    Segal, K, Shvero, J, Stern, Y,  et al. 1998Surgery of thyroid cancer in children and adolescentsHead Neck20293297CrossRefPubMedGoogle Scholar
  21. 21.
    Steinmuller, T, Klupp, J, Wenkings, S,  et al. 1999Complications associated with different surgical approaches in differentiated thyroid carcinomaArch. Surg.3845053Google Scholar
  22. 22.
    Haveman, JW, Tol, KM, Rouwe, CW,  et al. 2003Surgical experience in children with differentiated thyroid carcinomaAnn. Surg. Oncol.101520CrossRefPubMedGoogle Scholar
  23. 23.
    Jarzab, B, Handkiewicz Junak, DH, Wloch, J,  et al. 2000Multivariate analysis of prognostic factors for differentiated thyroid carcinoma in childrenEur. J. Nucl. Med.27833841CrossRefPubMedGoogle Scholar
  24. 24.
    Stael, APM, Plukker, JT, Piers, DA,  et al. 1995Total thyroidectomy in the treatment of thyroid carcinoma in childhoodBr. J. Surg.8210831085PubMedGoogle Scholar
  25. 25.
    Ortiz, S, Rodriguez, JM, Parrilla, P,  et al. 2001Recurrent papillary thyroid cancer: analysis of prognostic factors including the histological variantEur. J. Surg.167406412CrossRefPubMedGoogle Scholar
  26. 26.
    Soares, J, Limbert, E, Sobrinho-Somoes, M 1989Diffuse sclerosing variant of papillary thyroid carcinomaPathol. Res. Pract.185200206PubMedGoogle Scholar
  27. 27.
    Carcangiu, ML, Zampi, G, Pupi, A,  et al. 1985Papillary thyroid carcinoma of the thyroid: a clinicopathologic study of 241 cases treated at the University of Florence, ItalyCancer55805828PubMedGoogle Scholar
  28. 28.
    Acharya, S, Sarafoglu, K, Quaglia, M,  et al. 2003Thyroid neoplasms after therapeutic radiation for malignancy during childhood and adolescenceCancer9723972403CrossRefPubMedGoogle Scholar
  29. 29.
    Arush, MW, Stein, ME, Perez Nahum, M,  et al. 2000Pediatric thyroid carcinoma: 22 years of experience at the Northern Israel Oncology center (1973-1995)Pediatr. Hematol. Oncol.178592Google Scholar

Copyright information

© Société Internationale de Chirurgie 2004

Authors and Affiliations

  • Francoise Borson-Chazot
    • 1
  • Sylvain Causeret
    • 2
  • Jean-Christophe Lifante
    • 2
  • Marylin Augros
    • 3
  • Nicole Berger
    • 3
  • Jean-Louis Peix
    • 2
  1. 1.Centre de Médecine NucléaireHôpital CardiologiqueLyonFrance
  2. 2.Service de Chirurgie endocrinienneCentre Hospitalier Lyon-SudPierre-BéniteFrance
  3. 3.Service d’Anatomie-PathologiqueCentre Hospitalier Lyon-SudPierre-BéniteFrance

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