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Papillary Thyroid Carcinoma (PTC) in Children and Adults: Comparison of Initial Presentation and Long-Term Postoperative Outcome in 4432 Patients Consecutively Treated at the Mayo Clinic During Eight Decades (1936–2015)

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Abstract

Background

Contemporary guidelines for managing PTC advise an approach wherein primary tumor and regional metastases (RM) are completely resected at first surgery and radioiodine remnant ablation (RRA) is restricted to high-risk patients, policies our group has long endorsed. To assess our therapeutic efficacy, we studied 190 children and 4242 adults consecutively treated during 1936–2015.

Subjects and methods

Mean follow-up durations for children and adults were 26.9 and 15.2 years, respectively. Bilateral lobar resection was performed in 86% of children and 88% of adults, followed by RRA in 30% of children and 29% of adults; neck nodes were excised in 86% of children and 66% of adults. Tumor recurrence (TR) and cause-specific mortality (CSM) details were taken from a computerized database.

Results

Children, when compared to adults, had larger primary tumors which more often were grossly invasive and incompletely resected. At presentation, children, as compared to adults, had more RM and distant metastases (DM). Thirty-year TR rates were no different in children than adults at any site. Thirty-year CSM rates were lower in children than adults (1.1 vs. 4.9%; p = 0.01). Comparing 1936–1975 (THEN) with 1976–2015 (NOW), 30-year CSM rates were similar in MACIS <6 children (p = 0.67) and adults (p = 0.08). However, MACIS <6 children and adults in 1976–2015 had significantly higher recurrence at local and regional, but not at distant, sites. MACIS 6+ adults, NOW, compared to THEN, had lower 30-year CSM rates (30 vs. 47%; p < 0.001), unassociated with decreased TR at any site.

Conclusions

Children, despite presenting with more extensive PTC when compared to adults, have postoperative recurrences at similar frequency, typically coexist with DM and die of PTC less often. Since 1976, both children and adults with MACIS <6 PTC have a <1% chance at 30 years of CSM; adults with higher MACIS scores (6 or more) have a 30-year CSM rate of 30%.

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Acknowledgements

The documentation from one institution of 70,000 patient-years of PTC experience has required the cooperation of many Mayo Clinic colleagues and the support of the lead author’s wife, Professor Eileen Hay. Dr. Hay is particularly indebted to the late Drs. McConahey, Taylor and Woolner for initiating the careful documentation of outcome in the 1946–1970 cohort of PTC patients. This present study was supported by generous financial contributions from the Dr. RF Emslander Professorship, Colin V. and Brenda Reed from Nashville, TN, and the William Stamps Farish Fund.

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Authors and Affiliations

  1. Division of Endocrinology, Department of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    Ian D. Hay, Tammi R. Johnson & Nicole M. Iniguez-Ariza

  2. Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, 200 1st St SW, Rochester, MN, USA

    Suneetha Kaggal & Megan S. Reinalda

  3. Division of Endocrine Surgery, Department of Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    Clive S. Grant & Geoffrey B. Thompson

  4. Division of Pediatric Endocrinology, Department of Pediatrics, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    Siobhan T. Pittock

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  1. Ian D. Hay
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Correspondence to Ian D. Hay.

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Hay, I.D., Johnson, T.R., Kaggal, S. et al. Papillary Thyroid Carcinoma (PTC) in Children and Adults: Comparison of Initial Presentation and Long-Term Postoperative Outcome in 4432 Patients Consecutively Treated at the Mayo Clinic During Eight Decades (1936–2015). World J Surg 42, 329–342 (2018). https://doi.org/10.1007/s00268-017-4279-x

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