Total Thyroidectomy vs Thyroid Lobectomy for Localized Papillary Thyroid Cancer in Children: A Propensity-Matched Survival Analysis.

Abstract

INTRODUCTION\nCurrent guidelines recommend total thyroidectomy (TT) and radio-ablation for most papillary thyroid cancer (PTC) in children. These guidelines have been criticized as aggressive, especially for early-stage PTC, as it likely does not influence patient survival and results in life-long thyroid hormone replacement. We sought to study whether the extent of thyroidectomy (TT vs. thyroid lobectomy (TL)) influences the overall and disease-specific survival in children with localized PTC.\n\n\nMETHODS\nThe National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) registries were queried. Patients ≤18 years old with low-risk PTC between 2004 and 2016 were included. Using a 1:1 propensity score matching, patients who underwent TT were matched for age, sex, race, year of diagnosis, and tumor size- with a similar cohort of patients who underwent TL. Primary endpoints were overall survival (OS) and disease-specific survival (DSS).\n\n\nRESULTS\n3,500 patients were identified as surgically treated for PTC, out of which 1,325 patients met inclusion criteria for matching. Three hundred twenty-six patients were matched. One hundred sixty-three patients (140 females) with a mean age of 16(13- 17) had TT. One hundred sixty-three patients (140 females) with a mean age of 16(14- 17) had TL. Median follow-up was 5.0 (IQR 2.8, 8) and 8.3 (IQR 3.6 -14.4) years in the NCBD and SEER cohorts, respectively. There was no statistically significant difference in OS or DSS in patients with PTC < 4cm regardless of whether patients underwent a TT or TL [ P =0.32 (NCDB) and P = 0.67 (SEER)].\n\n\nCONCLUSION\nThis study suggests that the extent of thyroidectomy does not influence survival for pediatric patients with early-stage PTC and that TL may be adequate in this patient population.