Skip to main content
SpringerLink
Log in

Long-Term Outcome in 215 Children and Adolescents with Papillary Thyroid Cancer Treated During 1940 Through 2008

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Controversy exists regarding the aggressiveness of initial therapy in childhood papillary thyroid cancer (PTC). Few studies with long-term outcome exist and second primary malignancies have rarely been analyzed.

Methods

We studied 215 PTC patients younger than 21 years old managed during 1940 through 2008. The patients were aged 3–20 year old (median age = 16 years); the median follow-up was 29 years. Recurrence and mortality details were taken from a computerized database.

Results

Median primary tumor size was 2.2 cm. Six percent had distant metastases at presentation, 5% had incomplete tumor resection, 86% had nodes removed at initial surgery, and 78% had nodal metastases. After complete surgical resection, PTC recurred in 32% by 40 years. At 20 years, the recurrence rates at local, regional, and distant sites were 7, 21, and 5%, respectively. During 1940–1969, local and regional recurrence rates after unilateral lobectomy (UL) were significantly (P < 0.001) higher than after bilateral lobar resection (BLR). During 1950–2008 radioiodine remnant ablation (RRA) was administered within 18 months to 32%; it did not diminish the 25-year regional recurrence rate of 16% seen after BLR alone (P = 0.86). Only two fatal events from PTC occurred at 28 and 30 years, for a cause-specific mortality at 40 years of only 2%. All-causes mortality rates did not exceed expectation through 20 years, but from 30 through 50 years, the number of deaths was significantly (P < 0.001) higher than predicted. Fifteen of 22 deaths (68%) resulted from nonthyroid malignancy.

Conclusion

Survival from childhood PTC should be expected, but later death from nonthyroid malignancy is disconcerting. Seventy-three percent of those who died from nonthyroid malignancy had received postoperative therapeutic irradiation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Hogan AR, Zhuge Y, Perez EA et al (2009) Pediatric thyroid carcinoma: Incidence and outcomes in 1753 patients. J Surg Res 156(1):167–172

    Article  PubMed  Google Scholar 

  2. Zimmerman D, Hay ID, Gough IR et al (1988) Papillary thyroid carcinoma in children and adults: long-term follow-up of 1039 patients treated at one institution during three decades. Surgery 104:1157–1166

    CAS  PubMed  Google Scholar 

  3. Brink J, van Heerden J, McIver B et al (2000) Papillary thyroid cancer with pulmonary metastases in children: long-term prognosis. Surgery 128:881–886

    Article  CAS  PubMed  Google Scholar 

  4. Crile G (1959) Carcinoma of the thyroid in children. Ann Surg 150:959–964

    Article  PubMed  Google Scholar 

  5. LaQuaglia MP, Corbally MT, Heller G et al (1988) Recurrence and morbidity in differentiated thyroid carcinoma in children. Surgery 104:1149–1156

    CAS  Google Scholar 

  6. Ceccarelli C, Pacini F, Lippi F et al (1988) Thyroid cancer in children and adolescents. Surgery 104:1143–1148

    CAS  PubMed  Google Scholar 

  7. Demidchik YE, Demidchik EP, Reiners C et al (2006) Comprehensive clinical assessment of 740 cases of surgically treated thyroid cancer in children of Belarus. Ann Surg 243:525–532

    Article  PubMed  Google Scholar 

  8. Hallwirth U, Flores J, Kaserer K et al (1999) Differentiated thyroid cancer in children and adolescents: the importance of adequate surgery and review of literature. Eur J Pediatr Surg 9:359–363

    Article  CAS  PubMed  Google Scholar 

  9. Handkiewicz-Junak D, Wloch J, Roskosz J et al (2007) Total thyroidectomy and adjuvant radioiodine treatment independently decrease locoregional recurrence risk in childhood and adolescent differentiated thyroid cancer. J Nucl Med 48:879–888

    Article  CAS  PubMed  Google Scholar 

  10. Rachmiel M, Charron M, Gupta A et al (2006) Evidence-based review of treatment and followup of pediatric patients with differentiated thyroid carcinoma. J Pediatr Endocrinol Metab 19:1377–1393

    CAS  PubMed  Google Scholar 

  11. Hay ID, Thompson GB, Grant CS et al (2002) Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940–1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg 26:879–885

    Article  PubMed  Google Scholar 

  12. Hay ID, McDougall IR, Sisson JC (2008) Perspective: the case against radioiodine remnant ablation in patients with well-differentiated thyroid carcinoma. J Nucl Med 49:1395–1397

    Article  Google Scholar 

  13. Hay ID, McConahey WM, Goellner JR (2002) Managing patients with papillary thyroid carcinoma. Insights gained from the Mayo Clinic’s experience of treating 2, 521 consecutive patients during 1940 through 2000. Trans Am Clin Climatol Assoc 113:241–260

    PubMed  Google Scholar 

  14. Vassilopoulou-Sellin R, Goepfert H, Raney B et al (1998) Differentiated thyroid cancer in children and adolescents: clinical outcome and mortality after long-term follow-up. Head Neck 20:549–555

    Article  CAS  PubMed  Google Scholar 

  15. LiVolsi VA, Albores-Saavedra J, Asa SL (2004) Papillary carcinoma. In: DeLellis RA, Lloyd RV, Heitz PU, Eng C et al (eds) Pathology and genetics of tumours of endocrine organs: WHO Classification of Tumours. IARC Press, Lyon, pp 57–66

    Google Scholar 

  16. McConahey WM, Hay ID, Woolner LB et al (1986) Papillary thyroid cancer treated at the Mayo Clinic, 1946 through 1970: initial manifestations, pathologic findings, therapy and outcome. Mayo Clin Proc 61:978–996

    CAS  PubMed  Google Scholar 

  17. Peto R, Peto J (1972) Asymptotically efficient rank invariant procedures (with discussion). J R Stat Soc Ser A 135:185–207

    Article  Google Scholar 

  18. SAS Institute (1990) SAS/STAT user’s guide, version, 6th edn. SAS Institute, Cary

    Google Scholar 

  19. Hay ID, Bergstralh EJ, Goellner JR et al (1993) Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1, 779 patients surgically treated at one institution during 1940 through 1989. Surgery 114:1050–1058

    CAS  PubMed  Google Scholar 

  20. Cady B (1997) Our AMES is true: how an old concept still hits the mark: or, risk group assignment points the arrow to rational therapy selection in differentiated thyroid cancer. Am J Surg 174:462–468

    Article  CAS  PubMed  Google Scholar 

  21. Hay ID, Grant CS, Taylor WF et al (1987) Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic system. Surgery 102:1088–1095

    CAS  PubMed  Google Scholar 

  22. Hay ID, Hutchinson ME, Gonzalez-Losada T et al (2008) Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery 144:980–988

    Article  PubMed  Google Scholar 

  23. Hung W, Sarlis NJ (2002) Current controversies in the management of pediatric patients with well-differentiated nonmedullary thyroid cancer: a review. Thyroid 12:683–702

    Article  PubMed  Google Scholar 

  24. Bernstein L, Gurney JG (1999) Carcinomas and other malignant epithelial neoplasms. In: Ries LAG, Smith MA, Gurney JG et al (eds) Cancer incidence and survival among children and adolescents: United States SEER Program 1975–1995. National Cancer Institute, NIH Pub No 99-4649, Bethesda, Maryland, pp 139–147

  25. Harness JK (1997) Childhood thyroid carcinoma. In: Clark OH, Duh Q-Y (eds) Textbook of endocrine surgery. Saunders, Philadelphia, pp 75–81

    Google Scholar 

  26. Young JL, Percy CL, Asire AJ et al (1981) Cancer incidence and mortality in the United States, 1973–1977. Natl Cancer Inst Monogr 57:1

    PubMed  Google Scholar 

  27. Thompson GB, Hay ID (2004) Current strategies for surgical management and adjuvant treatment of childhood papillary thyroid carcinoma. World J Surg 28:1187–1198

    Article  PubMed  Google Scholar 

  28. Schlumberger M, De Vathaire F, Travagli JP et al (1987) Differentiated thyroid carcinoma in childhood: long-term follow-up of 72 patients. J Clin Endocrinol Metab 65:1088–1094

    Article  CAS  PubMed  Google Scholar 

  29. Jacob P, Goulko G, Heidenreich WF et al (1998) Thyroid cancer risk to children calculated. Nature 392:31–32

    Article  CAS  PubMed  Google Scholar 

  30. Haveman JW, van Tol KM, Rouwe CW et al (2003) Surgical experience in children with differentiated thyroid carcinoma. Ann Surg Oncol 10:15–20

    Article  PubMed  Google Scholar 

  31. Kowalski LP, Filho JG, Pinto CAL et al (2003) Long-term survival rates in young patients with thyroid carcinoma. Arch Otolaryngol Head Neck Surg 129:746–749

    Article  PubMed  Google Scholar 

  32. Giuffrida D, Scollo C, Pellegriti G et al (2002) Differentiated thyroid carcinoma in children and adolescents. J Endocrinol Invest 25:18–24

    CAS  PubMed  Google Scholar 

  33. Arici C, Erdogan O, Altunbas H et al (2002) Differentiated thyroid cancer in children and adolescents: clinical characteristics, treatment, and outcome of 15 patients. Horm Res 57:153–156

    Article  CAS  PubMed  Google Scholar 

  34. Grigsby PW, Gal-or A, Michalski JM et al (2002) Childhood and adolescent thyroid carcinoma. Cancer 95:724–729

    Article  PubMed  Google Scholar 

  35. Ben Arush MW, Stein ME, Nahum MP et al (2000) Pediatric thyroid carcinoma: 22 years of experience at the Northern Israel Oncology Center (1973–1995). Pediatr Hematol Oncol 17:75–92

    Google Scholar 

  36. Jarzab B, Junak DH, Wloch J et al (2000) Multivariate analysis of prognostic factors for differentiated thyroid carcinoma in children. Eur J Nucl Med 35:955–960

    Google Scholar 

  37. Landau D, Vini L, Ahern R et al (2000) Thyroid cancer in children: the Royal Marsden Hospital experience. Eur J Cancer 36:214–220

    Article  CAS  PubMed  Google Scholar 

  38. LaQuaglia MP, Black T, Holcomb GW et al (2000) Differentiated thyroid 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 Group. J Pediatr Surg 35:955–960

    Article  CAS  Google Scholar 

  39. Dinauer CA, Tuttle RM, Robie DK et al (1997) Clinical features associated with metastasis and recurrence of differentiated thyroid cancer in children, adolscents, and young adults. Clin Endocrinol (Oxf) 49:619–628

    Article  Google Scholar 

  40. Newman KD, Black T, Heller G et al (1998) Differentiated 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 Group. Ann Surg 227:533–541

    Article  CAS  PubMed  Google Scholar 

  41. Segald K, Shvero J, Stern Y et al (1998) Surgery of thyroid cancer in children and adolescents. Head Neck 20:293–297

    Article  Google Scholar 

  42. Vassilopoulou-Sellin R, Schultz PN, Haynie TP (1996) Clinical outcome of patients with papillary thyroid carcinoma who have recurrence after initial radioactive iodine therapy. Cancer 78:493–501

    Article  CAS  PubMed  Google Scholar 

  43. Josefson J, Zimmerman D (2008) Thyroid nodules and cancers in children. Pediatr Endocrinol Rev 6(1):14–23

    PubMed  Google Scholar 

  44. Dinauer CA, Breuer C, Rivkees SA (2008) Differentiated thyroid cancer in children: diagnosis and management. Curr Opin Oncol 20:59–65

    Article  PubMed  Google Scholar 

  45. Gingalewski CA, Newman KD (2006) Seminars: controversies in the management of pediatric thyroid malignancy. J Surg Oncol 94:748–752

    Article  PubMed  Google Scholar 

  46. Collini P, Mattavelli F, Spinelli C et al (2007) Treatment of sporadic nonmedullary thyroid carcinomas in pediatric age. Expert Rev Anticancer Ther 7:23–30

    Article  CAS  PubMed  Google Scholar 

  47. Collini P, Massimino M, Leite SF et al (2006) Papillary thyroid carcinoma of childhood and adolescence: a 30-year experience at the Istituto Nazionale Tumori in Milan. Pediatr Blood Cancer 46:300–306

    Article  PubMed  Google Scholar 

  48. Kirkland RT, Kirkland JL, Rosenberg HS (1973) Solitary thyroid nodules in 30 children and report of a child with a thyroid abscess. Pediatrics 51:85

    CAS  PubMed  Google Scholar 

  49. Harness JK, Thompson NW, Nishiyama RH (1971) Childhood thyroid carcinoma. Arch Surg 102:278

    CAS  PubMed  Google Scholar 

  50. Fowler CL, Pokorny WJ, Harberg FJ (1989) Thyroid nodules in children: current profile of changing disease. South Med J 82:1472

    CAS  PubMed  Google Scholar 

  51. Harness JK, Thompson NW, McLeod MK et al (1992) Differentiated thyroid carcinoma in children and adolescents. World J Surg 16:547–554

    Article  CAS  PubMed  Google Scholar 

  52. Mazzaferri EL (1999) NCCN thyroid carcinoma practice guidelines. Oncology 13:391–416

    Google Scholar 

  53. Paryani SB, Chobe RJ, Scott W et al (1996) Management of thyroid carcinoma with radioactive I-131. Int J Radiat Oncol Biol Phys 36:S83–S86

    Google Scholar 

  54. Gorlin JB, Sallen SE (1990) Thyroid cancer in childhood. Endocrinol Metab Clin North Am 19:649–662

    CAS  PubMed  Google Scholar 

  55. Desjardins JG, Bass J, Leboeuf G et al (1988) A twenty-year experience with thyroid carcinoma in children. J Pediatr Surg 23:709–713

    Article  CAS  PubMed  Google Scholar 

  56. McClellan DR, Francis GL (1996) Thyroid cancer in children, pregnant women, and patients with Graves’ disease. Endocrinol Metab Clin North Am 25:27–48

    Article  CAS  PubMed  Google Scholar 

  57. Welch Dinauer CA, Tuttle RM, Robie DK et al (1998) Clinical features associated with metastasis and recurrence of differentiated thyroid cancer in children, adolescents, and young adults. Clin Endocrinol (Oxf) 49:619–628

    Article  CAS  Google Scholar 

  58. Sykes AJ, Gattamanen HR (1997) Carcinoma of the thyroid in children: a 25-year experience. Med Pediatr Oncol 29:103–107

    Article  CAS  PubMed  Google Scholar 

  59. Fassina AS, Rupolo M, Pelizzo MR et al (1994) Thyroid cancer in children and adolescents. Tumori 80:257–262

    CAS  PubMed  Google Scholar 

  60. Danese D, Gardini A, Farsetti A et al (1997) Thyroid carcinoma in children and adolescents. Eur J Pediatr 156:190–194

    Article  CAS  PubMed  Google Scholar 

  61. Dottorini ME, Vignati A, Mazzucchelli L et al (1997) Differentiated thyroid carcinoma in children and adolescents: a 37-year experience in 85 patients. J Nucl Med 38:669–675

    CAS  PubMed  Google Scholar 

  62. Yeh SD, La Quaglia MP (1997) I-131 therapy for pediatric thyroid cancer. Semin Pediatr Surg 6:128–133

    CAS  PubMed  Google Scholar 

  63. Winters S, Berga S (1997) Gonadal dysfunction in patients with thyroid disorders. Endocrinologist 7:167–173

    Article  Google Scholar 

  64. Garsi JP, Schlumberger M, Ricard M et al. (2009) Health outcomes of children fathered by patients treated with radioiodine for thyroid cancer. Clin Endocrinol (Oxf) (Epub ahead of print)

  65. Sisson JC (1989) Medical treatment of benign and malignant thyroid tumors. Endocrinol Metab Clin North Am 18:359–387

    CAS  PubMed  Google Scholar 

  66. Rubino C, de Vathaire F, Dottorini ME et al (2003) Second primary malignancies in thyroid cancer patients. Br J Cancer 89:1638–1644

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Ian D. Hay, Tomas Gonzalez-Losada & Jennifer A. Honetschlager

  2. Division of Biostatistics, Mayo Clinic, Rochester, MN, 55905, USA

    Megan S. Reinalda

  3. Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN, 55905, USA

    Melanie L. Richards & Geoffrey B. Thompson

Authors
  1. Ian D. Hay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomas Gonzalez-Losada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Megan S. Reinalda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer A. Honetschlager
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Melanie L. Richards
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Geoffrey B. Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ian D. Hay.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hay, I.D., Gonzalez-Losada, T., Reinalda, M.S. et al. Long-Term Outcome in 215 Children and Adolescents with Papillary Thyroid Cancer Treated During 1940 Through 2008. World J Surg 34, 1192–1202 (2010). https://doi.org/10.1007/s00268-009-0364-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-009-0364-0

Keywords

Search

Navigation