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      “Clinicopathological features and treatment outcomes of differentiated thyroid cancer in Saudi children and adults”

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          Abstract

          Introduction

          Age is an important prognostic factor in differentiated thyroid cancer (DTC). Our aim was to evaluate differences in clinicopathological features and treatment outcomes among children and adult patients with DTC.

          Materials and methods

          We studied 27 children (below 18 years) with DTC treated during the period 2000–2012 and were compared with (a) 78 adults aged 19–25 years and (b) 52 adults aged 26–30 years treated during the same period in terms of their clinicopathological features and long term treatment outcomes. Locoregional recurrence (LRR), locoregional control (LRC), distant metastasis (DM), distant metastasis control (DMC), disease free survival (DFS) and overall survival (OS) rates were evaluated.

          Results

          Mean age of children was 13.5 years (range: 5–18), while mean age of adults was 24.6 years (range: 19–30). In children, female: male ratio was 2.85:1, and in adults female: male ratio was 7.1:1 ( P = 0.041). No significant difference in tumor size was seen between the two groups ( P = 0.653). According to American Thyroid Association (ATA) risk stratification classification, the children (85.2 %) were found to have at high risk as compared to adults P = 0.001. Post-thyroidectomy complications and RAI induced toxicities were observed more in children than adults ( P = 0.043 and P = 0.041 respectively). LRR occurred in 6 (22.2 %), 9 (11.5 %) and 3 (5.8 %) in age groups of <18 years, 19–25 years and 26–30 years respectively ( P = 0.032); while DM was seen in 10 (37.0 %), 9 (10.3 %) and 5 (9.6 %) in age groups of <18 years, 19–25 years and 26–30 years respectively ( P = 0.002). Ten year DFS rates were 67.3 % in age group below 18 years, 82.4 % in age group of 19–25 years and 90.1 % in age group of 26–30 years ( P = 0.021).

          Conclusion

          At the time of diagnosis, children with DTC were found to have more aggressive clinicopathological characteristics. Comparatively lower LRC, DMC and DFS rates in children warrants further multi-institutional studies.

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          Most cited references23

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          Pediatric thyroid carcinoma: incidence and outcomes in 1753 patients.

          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.
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            Long-term outcome in 215 children and adolescents with papillary thyroid cancer treated during 1940 through 2008.

            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. 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. 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. 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.
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              Increase in the incidence of differentiated thyroid carcinoma in children, adolescents, and young adults: a population-based study.

              To investigate trends in incidence of differentiated thyroid carcinomas among children and adolescents and young adults.
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                Author and article information

                Contributors
                +96612889999 , kalqahtani@KSU.EDU.SA
                +96612889999 , drmutahirtonio@hotmail.com
                966 1 2889999 , masiri@kfmc.med.sa
                966 1 2889999 , njaljohani@kfmc.med.sa
                yasserbayoumi777@yahoo.com
                966 1 2889999 , kriaz@kfmc.med.sa
                +96612889999 , walshakweer@kfmc.med.sa
                Journal
                J Otolaryngol Head Neck Surg
                J Otolaryngol Head Neck Surg
                Journal of Otolaryngology - Head & Neck Surgery
                BioMed Central (London )
                1916-0208
                1916-0216
                6 November 2015
                6 November 2015
                2015
                : 44
                : 48
                Affiliations
                [ ]Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
                [ ]Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
                [ ]Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, 59046 Saudi Arabia
                [ ]Endocrinology and Thyroid Oncology, King Fahad Medical City, Riyadh, 59046 Saudi Arabia
                [ ]Radiation Oncology, NCI, Cairo University, Cairo, Egypt
                [ ]Histopathology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, 59046 Saudi Arabia
                Article
                102
                10.1186/s40463-015-0102-6
                4636902
                26546329
                e40b1f7f-e480-4059-a9e2-c2a95f1948ea
                © AL-Qahtani et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 5 February 2015
                : 2 November 2015
                Categories
                Original Research Article
                Custom metadata
                © The Author(s) 2015

                differentiated thyroid cancers,children,adults,clinicopathological characteristics,treatment outcomes

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