To examine outcomes and predictors of survival for pediatric patients with thyroid
carcinoma.
The Surveillance, Epidemiology, and End Results (SEER) registry from 1973 to 2004
was queried for all patients with thyroid carcinoma less than 20 y of age.
A total of 1753 patients with malignant thyroid neoplasms were identified with an
age-adjusted annual incidence of 0.54 cases per 100,000 persons. There has been a
significant increase in the annual incidence by 1.1% per y. Female patients outnumbered
males 4 to 1. Tumors were classified as papillary (n=1044, 60%), follicular variant
of papillary (n=389, 23%), follicular (n=165, 10%), and medullary (n=87, 5%). The
majority of patients presented with localized and regional disease. Overall mean survival
time (MST) was 30.5 y. The MST for females was 40 y, whereas males survived an average
of 20.4 y (P=0.0001). Patients with medullary cancer had significantly shorter mean
survival than those with papillary cancer (P=0.006). Surgical treatment significantly
improved outcome. Multivariate analysis demonstrated that male gender, nonpapillary
histology, distant disease, and no surgery were all independent prognostic factors
of worse outcome. For patients with medullary thyroid carcinoma, radiation therapy
was also identified as an independent predictor of lower survival.
The incidence of pediatric thyroid cancer is increasing. Females have a higher incidence
than males, but enjoy longer survival. Papillary thyroid cancer has overall excellent
survival. Male gender, nonpapillary tumor, distant metastases, and nonsurgical treatment
all predict worse outcome.