The impact of initial surgical management on outcome in young patients with differentiated thyroid cancer

Robie, Daniel K.; Dinauer, Catherine; Tuttle, R. Michael; Ward, David T.; Parry, Robert L.; McClellan, Donald R; Svec, Rita L; Adair, Carol F.; Francis, Gary L.

doi:10.1016/s0022-3468(98)90546-2

Cited by 52 publications

(26 citation statements)

References 12 publications

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“…Lately, more and more authors claim that lymph node metastases adversely influence disease-free survival in patients with DTC (32,33). Indeed, in our univariate analysis, children with lymph node metastases or unknown cervical lymph node status at the primary surgery had a worse prognosis than those with lymph node involvement excluded by negative surgical biopsy.…”

Section: Discussionmentioning

confidence: 72%

Total Thyroidectomy and Adjuvant Radioiodine Treatment Independently Decrease Locoregional Recurrence Risk in Childhood and Adolescent Differentiated Thyroid Cancer

Handkiewicz-Junak

Włoch²,

Roskosz³

et al. 2007

Journal of Nuclear Medicine

184

139

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We sought to assess whether extensive surgical treatment, postsurgical radioiodine therapy, or both decrease the risk of locoregional recurrence (LR) after curative primary treatment in children and adolescents diagnosed with differentiated thyroid cancer (DTC) at age #18 y. Methods: To determine the incidence of and identify predictive factors for thyroid bed recurrence (TBR) or lymph node recurrence (NR), we performed a chart review and retrospective multivariate Cox regression analysis on 235 patients with DTC diagnosed at age #18 y and managed with curative intent at our tertiary referral center from 1973 to 2002; 40 of these patients had distant metastases at diagnosis. We also determined overall and recurrence-free survival and generated curves for these variables using Kaplan-Meier and Cox univariate analysis. Results: During a median follow-up of 82 mo (range, 5-402 mo), no DTC-related deaths occurred, 203 (86%) children remained recurrence-free, and 32 (14%) children had LR, including TBR in 9 (28% of LR), NR in 20 (63% of LR), and both in 3 (9% of LR). Among patients treated with radical intent and showing no distant metastases, the most recent thyroglobulin level was ,1 ng/mL in all but 4% of cases. The median time from the first surgery to LR was 37 mo (range, 9-280 mo). In multivariate analysis, significant risk factors for TBR were less than total thyroidectomy and lack of postsurgical radioiodine treatment (respective risk increases of 9.5 [P 5 0.04] and 11 times [P 5 0.03]). For NR, classic papillary histology, incomplete primary lymph node management (i.e., lack of modified lymphadenectomy of affected lymph nodes or lack of confirmation of disease-free nodes by intraoperative staging), and absence of adjuvant radioiodine therapy were independent significant predictive factors that increased the recurrence risk by 1.9 (P 5 0.02), 3.3 (P 5 0.02), and 3.2 (P 5 0.02) times, respectively. Age or sex did not correlate with LR risk. Conclusion: In DTC patients #18 y of age, extensive initial therapy-consisting of total thyroidectomy combined with modified lymphadenectomy performed in case of lymph node metastases and followed by radioiodine therapy-is associated with a substantial decrease of DTC LR risk.

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Section: Discussionmentioning

confidence: 72%

Total Thyroidectomy and Adjuvant Radioiodine Treatment Independently Decrease Locoregional Recurrence Risk in Childhood and Adolescent Differentiated Thyroid Cancer

Handkiewicz-Junak

Włoch²,

Roskosz³

et al. 2007

Journal of Nuclear Medicine

184

139

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“…Thyroid nodules in children and adolescents are almost ten times more often malignant than in adults [4]. Lymphonodal involvement is commonly present at first clinical presentation (35%-83%) and pulmonary metastases could be encountered in up to 16% [5][6][7][8][9][10]. The local and distance recurrence age of 14, two years prior to diagnosis of PTC.…”

mentioning

confidence: 99%

Surgical management of well-differentiated thyroid carcinoma in children and adolescents: 33 years of experience of a single institution in Serbia

et al. 2014

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“…Advocates of a less extensive resection (lobectomy or subtotal thyroidectomy without lymph node dissection) support this approach with the excellent survival statistics of young patients with PTC and higher incidence of surgical complications associated with more aggressive resection [6,11,12]. Those that support a more extensive surgical approach ab initio (total or near-total thyroidectomy with lymphadenectomy) argue that the often multifocal nature of PTC and its high rate of nodal and distal metastases will lead to increased morbidity from disease recurrence [13].…”

mentioning

confidence: 99%

The role of a more extensive surgical approach in the initial multimodality management of papillary thyroid cancer in children

Savio

Gosnell

Palazzo

et al. 2005

Journal of Pediatric Surgery

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The impact of initial surgical management on outcome in young patients with differentiated thyroid cancer

Cited by 52 publications

References 12 publications

Total Thyroidectomy and Adjuvant Radioiodine Treatment Independently Decrease Locoregional Recurrence Risk in Childhood and Adolescent Differentiated Thyroid Cancer

Total Thyroidectomy and Adjuvant Radioiodine Treatment Independently Decrease Locoregional Recurrence Risk in Childhood and Adolescent Differentiated Thyroid Cancer

Surgical management of well-differentiated thyroid carcinoma in children and adolescents: 33 years of experience of a single institution in Serbia

The role of a more extensive surgical approach in the initial multimodality management of papillary thyroid cancer in children

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