The incidence of thyroid cancer, the third most common malignancy in children, is known to be increasing approximately 1% a year. Now a new analysis of the National Cancer Data Base (NCDB)—a joint program of the Commission on Cancer of the American College of Surgeons and the American Cancer Society containing approximately 26 million records—indicates that although the proportion of young patients undergoing total thyroidectomy increased by 34% between 1985 and 2007, a variety of hospital and patient factors, including disparities in access to surgeons and state-of-the-art care, affect whether a child actually receives this procedure or another less extensive operation.
The analysis, published in the October issue of Annals of Surgical Oncology (2010;17:1245-2553), was performed by surgeons who examined data on approximately 8,000 patients age 21 or younger with differentiated thyroid cancer whose case records were collected by the NCDB.
Lead study author Mehul V. Raval, MD, noted in a news release that pediatric thyroid cancer—the most common endocrine cancer in children—is often diagnosed at an advanced stage, but the disease is highly treatable. Because the overall rate of complications is higher for a repeat thyroid procedure than for most other surgical procedures, experts believe that having only one thyroid operation is of crucial importance.
Thus, the thought is that total thyroidectomy is the best care available for treating this condition and preventing a recurrence. Even so, less extensive operations—such as near total thyroidectomy or lobectomy are thought to be lower risk, but a second operation may be required to treat residual disease left behind.
“In recent years we have been observing a trend in which surgeons are electing to use total thyroidectomy as the first-line modality to treat pediatric thyroid cancers,” said Dr. Raval, an American College of Surgeons Research Fellow at the time the analysis was performed and now a surgical resident at Northwest University Feinberg School of Medicine.
The researchers therefore sought to identify factors associated with the likelihood of undergoing total thyroidectomy as compared with near total thyroidectomy or lobectomy.
Patients with larger tumors were found to be 38% more likely to undergo total thyroidectomy compared with patients with smaller tumors. The analysis also revealed, however, that young patients treated in the highest-volume hospitals were 36% more likely to receive total thyroidectomy than patients cared for at low-volume hospitals, and that Cancer Oncology Group centers were 26% more likely to perform the total procedure than nonspecialty centers were.
Other factors that increased a patient's likelihood of receiving total thyroidectomy included having higher household income, private insurance vs government insurance, and living in the southern and the western regions of the United States.
“Our study confirms the pattern we suspected based on individual institutional reports now using a large national cohort of patients,” Dr. Raval said. “These findings should encourage centers that are performing less than a total thyroidectomy to consider changing their practice.”
“Our study confirms the pattern we suspected based on individual institutional reports now using a large national cohort of patients. These findings should encourage centers that are performing less than a total thyroidectomy to consider changing their practice.”