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Dan J, Tan J, Guo Y, Xu Y, Zhou L, Huang J, Yuan Z, Ai X, Li J. Construction and validation of a nomogram for predicting lateral lymph node metastasis in pediatric and adolescent with differentiated thyroid carcinoma. Endocrine 2024; 84:1088-1096. [PMID: 38367146 PMCID: PMC11208251 DOI: 10.1007/s12020-024-03730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 02/04/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Limited research has been conducted to specifically investigate the identification of risk factors and the development of prediction models for lateral lymph node metastasis (LNM) in pediatric and adolescent differentiated thyroid carcinoma (DTC) populations, despite its significant association with unfavorable prognosis. METHODS This study entails a retrospective analysis of the clinical characteristics exhibited by pediatric and adolescent patients who have been diagnosed with DTC. The data utilized for this analysis was sourced from the Surveillance, Epidemiology, and End Results (SEER) database, spanning the time frame from 2000 to 2020. Furthermore, the study incorporates patients who were treated at the Departments of Breast and Thyroid Surgery in the Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, as well as The General Hospital of Western Theater Command, during the period from 2010 to 2020. RESULTS A cohort of 2631 patients from the SEER database, along with an additional 339 patients from our departments who met the specified inclusion criteria, were included in this study. Subsequently, four clinical variables, namely age, tumor size, multifocality, and extrathyroidal invasion, were identified as being significantly associated with lateral LNM in pediatric and adolescent DTC patients. These variables were then utilized to construct a nomogram, which demonstrated effective discrimination with a concordance index (C-index) of 0.731. Furthermore, the performance of this model was validated through both internal and external assessments, yielding C-index values of 0.721 and 0.712, respectively. Afterward, a decision curve analysis was conducted to assess the viability of this nomogram in predicting lymph node metastasis. CONCLUSION The current investigation has effectively constructed a nomogram model utilizing visualized multipopulationsal data. Our findings demonstrate a significant association between various clinical characteristics and lateral LNM in pediatric and adolescent DTC patients. These outcomes hold substantial significance for healthcare practitioners, as they can employ this model to inform individualized clinical judgments for the pediatric and adolescent cohorts.
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Affiliation(s)
- Jiaqiang Dan
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Thyroid and Breast Surgery, Chengdu Fifth People's Hospital (The Second Clincal Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), NO.33 Ma Shi Street, Wenjiang District, Chengdu, 611137, China
| | - Jingya Tan
- Department of Rheumatology and Immunology, Wenjiang District People's Hospital of Chengdu City, No.86, Kangtai Road, Wenjiang District, Chengdu, 611137, China
| | - Yao Guo
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Thyroid and Breast Surgery, Chengdu Fifth People's Hospital (The Second Clincal Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), NO.33 Ma Shi Street, Wenjiang District, Chengdu, 611137, China
| | - Yang Xu
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Thyroid and Breast Surgery, Chengdu Fifth People's Hospital (The Second Clincal Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), NO.33 Ma Shi Street, Wenjiang District, Chengdu, 611137, China
| | - Lin Zhou
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Thyroid and Breast Surgery, Chengdu Fifth People's Hospital (The Second Clincal Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), NO.33 Ma Shi Street, Wenjiang District, Chengdu, 611137, China
| | - Junhua Huang
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Thyroid and Breast Surgery, Chengdu Fifth People's Hospital (The Second Clincal Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), NO.33 Ma Shi Street, Wenjiang District, Chengdu, 611137, China
| | - Zhiying Yuan
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Thyroid and Breast Surgery, Chengdu Fifth People's Hospital (The Second Clincal Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), NO.33 Ma Shi Street, Wenjiang District, Chengdu, 611137, China
| | - Xiang Ai
- Department of Thyroid and Breast Surgery, The General Hospital of Western Theater Command, No. 270, Day loop, Rongdu Avenue, Jinniu District, Chengdu, 610000, China.
| | - Junyan Li
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Thyroid and Breast Surgery, Chengdu Fifth People's Hospital (The Second Clincal Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), NO.33 Ma Shi Street, Wenjiang District, Chengdu, 611137, China.
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Ngo DQ, Le DT, Ngo QX, Van Le Q. Transoral endoscopic thyroidectomy vestibular approach as a novel technique for pediatric populations: Results from a single surgeon. Front Endocrinol (Lausanne) 2023; 14:1177633. [PMID: 37334309 PMCID: PMC10272734 DOI: 10.3389/fendo.2023.1177633] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023] Open
Abstract
Background The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is increasingly being adopted worldwide because of its many advantages. However, there are few reports on the effectiveness and safety of TOETVA in children. In this study, we report the results of the application of TOETVA on 27 pediatric patients in Vietnam. To the best of our knowledge, this is also the largest sample size of the TOETVA technique performed by a single surgeon on pediatric patients worldwide. Patients and methods: From June 2020 to February 2022, we performed TOETVA on 27 pediatric patients (≤ 18 years old). The outcomes of the procedure were retrospectively reviewed. Results Our study was conducted on 27 pediatric patients, of whom 24 were female (88.9%). The mean age was 16.3 ± 2 (range 10-18). Fifteen patients had benign thyroid nodules with a mean nodule size of 31.6 ± 7.1 (range 20-50mm), and 12 patients had papillary thyroid carcinoma with a mean nodule size of 10.2 ± 5.6 (range 4-19mm). All 27 patients underwent successful TOETVA without any conversion to open surgery. The 15 patients with benign thyroid nodules had lobectomies with a mean operative time of 83.3 ± 10.5 (range 60-105 minutes). Among the 12 patients diagnosed with thyroid cancer, ten had a lobectomy, isthmusectomy, and central neck dissection, with a mean operative time of 89.8 ± 5.7 (range 80-100 minutes). The other two underwent total thyroidectomy with central lymph node dissection with a mean operative time of 132.5 minutes. The mean hospital stay was 4.7 ± 0.9 (range 3-7 days). No patient had permanent complications, such as hypocalcemia, recurrent laryngeal nerve injury, or mental nerve injury. The rates of temporary recurrent laryngeal nerve injury and mental nerve injury were 3.7% and 11.1% respectively. Conclusions TOETVA may be a feasible and safe surgical method for children with thyroid disease. However, we recommend that only high-volume thyroid surgeons with experience in TOETVA should perform TOETVA on the pediatric population.
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Affiliation(s)
- Duy Quoc Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Duong The Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Quy Xuan Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Quang Van Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
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Hafez LG, Elkomos BE, El-Shafaei MAM, Omran HMA, Saad AS. The risk of central nodal metastasis based on prognostic factors of the differentiated thyroid carcinoma: a systematic review and meta-analysis study. Eur Arch Otorhinolaryngol 2023; 280:2675-2686. [PMID: 36759363 PMCID: PMC10175472 DOI: 10.1007/s00405-023-07863-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND AIM Despite improving the 10-year disease-free-survival, prophylactic central neck dissection (pCND) in differentiated thyroid carcinoma (DTC) should only be considered in patients with high risk factors for lymph node (LN) metastasis due to the increases in the risk of postoperative complications. Our aim was to identify the risk factors for central lymph node metastasis (CLNM) in DTC. METHOD We searched PubMed, Scopus, Web of science, Cochrane library for eligible studies from inception to November 1, 2021 and a systematic review and meta-analysis were carried out to identify the risk factors for CLNM in DTC. RESULTS We included 41 studies with total of 27,741 patients in this study. The pooled results in this meta-analysis showed that these risk factors were significantly associated with CLNM: age < 45 years (odds ratio (OR) 1.64, 95% confidence interval (CI) 1.34-1.99, p < 0.00001), male sex (OR 1.73, 95% CI 1.54-1.93, p < 0.00001), multifocality (OR 1.87, 95% CI 1.59-2.19, p < 0.00001), bilateral disease (OR 1.43, 95% CI 1.15-1.78, p < 0.001), capsular invasion (OR 1.67, 95% CI 1.10-2.54, p < 0.02), lymphovascular invasion (OR 4.89, 95% CI 2.76-8.66, p < 0.00001) and extra-thyroidal extension (OR 2.43, 95% CI 1.97-3.00, p < 0.00001). In addition, young age (< 45 years), male sex, multifocality, and extra-thyroidal extension were significantly associated with large-volume CLNM in clinically N0 DTC patients. However, the presence of Hashimoto's thyroiditis was not a predictors of large-volume CLNM. CONCLUSION Young age (< 45 years), male sex, bilateral disease, multifocality, capsular invasion, lymphovascular invasion and extra-thyroidal extension are significantly associated with CLNM and pCND would be expected to have a higher yield in patients with these risk factors.
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Affiliation(s)
- Lamiaa Gomaa Hafez
- General Surgery Department, Faculty of Medicine, Ain Shams University, Tomanbia Street, Elzytoon, Cairo, Egypt
| | - Beshoy Effat Elkomos
- General Surgery Department, Faculty of Medicine, Ain Shams University, Tomanbia Street, Elzytoon, Cairo, Egypt
| | | | - Hesham Mohamed Ali Omran
- General Surgery Department, Faculty of Medicine, Ain Shams University, Tomanbia Street, Elzytoon, Cairo, Egypt
| | - Ahmed Saeed Saad
- General Surgery Department, Faculty of Medicine, Ain Shams University, Tomanbia Street, Elzytoon, Cairo, Egypt
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Thiesmeyer JW, Egan CE, Greenberg JA, Beninato T, Zarnegar R, Fahey Iii TJ, Finnerty BM. Prepubertal Children with Papillary Thyroid Carcinoma Present with More Invasive Disease Than Adolescents and Young Adults. Thyroid 2023; 33:214-222. [PMID: 36355601 DOI: 10.1089/thy.2022.0098] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction: Pediatric papillary thyroid carcinomas (PTCs) are more invasive than adult PTCs. No large, contemporary cohort study has been conducted to determine whether younger children are at higher risk for advanced disease at presentation compared to adolescents. We aimed to describe pediatric PTC and contextualize its characteristics with a young adult comparison cohort. Methods: The National Cancer Database was interrogated for pediatric and young adult PTCs diagnosed between 2004 and 2017. Clinical variables were compared between prepubertal (≤10 years old), adolescent (11-18 years old), and young adult (19-39 years old) groups. Multivariable logistic regression modeling for independent predictors of metastases was conducted. A subanalysis of microcarcinomas (size ≤10 mm) was performed. Results: A total of 4860 pediatric (prepubertal n = 274, adolescents n = 4586) and 101,159 young adult patients were included. Prepubertal patients presented with more extensive burden of disease, including significantly larger primary tumors, higher prevalence of nodal and distant metastases, and increased frequency of features such as lymphovascular invasion, and extrathyroidal extension (ETE). Prepubertal age was an independent predictor of positive regional nodes (adjusted odds ratio [AOR] = 1.36 [95% confidence interval {CI} 1.01-1.84], p = 0.04) and distant metastatic disease (AOR = 3.12 [CI 1.96-4.96], p < 0.001). However, there was no difference in survival between groups (p = 0.32). Prepubertal age independently predicted lymph node metastases for microcarcinomas (AOR = 2.19 [CI 1.10-4.36], p = 0.03). Prepubertal (n = 41) versus adolescent (n = 937) patient age was associated with gross ETE (p = 0.004), even with primary tumors ≤1 cm in size. Conclusions: Patients aged <11 years old present with more advanced disease than adolescents, with a higher likelihood of nodal and distant metastatic disease at time of diagnosis, although survival is high. Prepubertal children undergo more extensive treatment, likely reflective of more invasive disease at the outset, even in the setting of a subcentimeter primary tumor.
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Affiliation(s)
- Jessica W Thiesmeyer
- Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Caitlin E Egan
- Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jacques A Greenberg
- Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Toni Beninato
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rasa Zarnegar
- Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Thomas J Fahey Iii
- Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Brendan M Finnerty
- Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA
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Ngo DQ, Le DT, Ngo QX, Van Le Q. Risk factors for lateral lymph node metastasis of papillary thyroid carcinoma in children. J Pediatr Surg 2022; 57:421-424. [PMID: 35168812 DOI: 10.1016/j.jpedsurg.2022.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/10/2021] [Accepted: 01/05/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Lateral cervical lymph node metastases (LNM) for pediatric patients with papillary thyroid cancer (PTC) is a poor prognostic factor. We aimed to identify risk factors for lateral LNM. METHODS This retrospective study had included 48 pediatric patients with papillary thyroid cancer underwent total thyroidectomy and central cervical lymphadenectomy at K hospital from 2016 to 2020. RESULTS The number of patients in each T stage was as follows: 24 (50.0%) in stage 1, 9 (18.7%) in Stage 2, 8 (16.7%) in Stage 3, and 7 (14.6%) in Stage 4. Most of the patients had LNM with N1a and N1b rates of 83.3% and 62.5%, respectively. Lung metastases were observed at presentation in three patients (6.3%). Univariate analysis revealed that age (p = 0.021), male (p = 0.011), tumor size > 10 mm (p = 0.002), multifocality (p < 0.001), extrathyroidal extension (p = 0.001) and central LNM (p < 0.001) were factors that increase the risk of metastasis to lateral LNM. CONCLUSION Approximately 62.5% of pediatric patients with PTC exhibited lateral LNM at the time of diagnosis. Our study confirmed that multifocality, maximum tumor diameter, extrathyroidal extension and central LNM were independent risk factors for lateral LNM in pediatric PTC. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Duy Quoc Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, 30 Cau Buou Street, Thanh Tri District, Hanoi, Vietnam; Hanoi Medical University, 01 Ton That Tung Street, Dong Da District, Hanoi, Vietnam
| | - Duong The Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, 30 Cau Buou Street, Thanh Tri District, Hanoi, Vietnam.
| | - Quy Xuan Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, 30 Cau Buou Street, Thanh Tri District, Hanoi, Vietnam
| | - Quang Van Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, 30 Cau Buou Street, Thanh Tri District, Hanoi, Vietnam; Hanoi Medical University, 01 Ton That Tung Street, Dong Da District, Hanoi, Vietnam
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Li C, Gao Y, Zhou P, Yue T, Xu J, Shao C, Liu Y, Zhuang D, He Q, Li X. Comparison of the Robotic Bilateral Axillo-Breast Approach and Conventional Open Thyroidectomy in Pediatric Patients: A Retrospective Cohort Study. Thyroid 2022; 32:1211-1219. [PMID: 35943878 DOI: 10.1089/thy.2022.0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Operations for pediatric thyroid nodules are more complicated, and usually lead to longer scars, which may impair life quality in the long term. Bilateral axillo-breast approach robotic thyroidectomy (BABA RT) may provide a better alternative to conventional open thyroidectomy (COT) for pediatric thyroid nodules. Our study aimed at comparing the surgical and oncological outcomes of BABA RT and COT in pediatric patients. Methods: The data of 49 pediatric patients who consecutively underwent BABA RT or COT (20:29) between July 1998 and November 2021 in our center were retrospectively analyzed, including demographics, surgery extent, surgical outcomes, pathological characteristics, and oncological outcomes. Results: All BABA RT procedures were completed successfully without conversion to open operation. The BABA RT group consisted of 5 benign and 15 malignant cases, while the COT group consisted of 19 benign and 10 malignant cases. The operation time, drain removal time, and number of lymph nodes harvested by central lymph node dissection or lateral lymph node dissection were equivalent in the BABA RT and COT groups. Notably, the postoperative hospital stay of the BABA RT group was shorter than that of the COT group (8.5 [interquartile ranges (IQRs): 3] vs. 11 [IQR: 8] days, p = 0.008). The aesthetic score of the BABA RT group was much higher than that of the COT group (9 [IQR: 1] vs. 6 [IQR: 1], p < 0.001). There was no significant difference between the BABA RT and COT groups in hypoparathyroidism rate (transient, 5 vs. 4; permanent, 1 vs. 0). There was one case of chyle leakage in the COT group and no other complications in any group, such as recurrent laryngeal nerve injury. With a median follow-up of 101 (IQR: 189) months, one case of local relapse and one case of pulmonary metastasis in the COT group were documented. Conclusion: In the hands of experienced surgeons, robotic BABA thyroidectomy can be a safe and effective option for both benign and malignant thyroid nodules in children, including those with lymph node metastasis. Robotic BABA thyroidectomy can offer a better and faster postoperative course and a much better cosmetic result, which is crucial for pediatric thyroid patients.
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Affiliation(s)
- Chenyu Li
- Jinzhou Medical University, Jinzhou, Liaoning, China
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Yuan Gao
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
- Department of General Surgery, the 963rd Hospital of People's Liberation Army, Jiamusi, China
- Department of Hepatobiliary Surgery, Xi-Jing Hospital, Fourth Military Medical University, Xi'an, China
| | - Peng Zhou
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Tao Yue
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Jing Xu
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Changxiu Shao
- Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Yongxiang Liu
- Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Dayong Zhuang
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Qingqing He
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Xiaolei Li
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
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Ngo DQ, Le DT, Le Q. Prophylactic Central Neck Dissection to Improve Disease-Free Survival in Pediatric Papillary Thyroid Cancer. Front Oncol 2022; 12:935294. [PMID: 35965553 PMCID: PMC9368579 DOI: 10.3389/fonc.2022.935294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Pediatric PTC is a rare disease. Although, the prognosis is excellent and the mortality rate is low, the role of prophylactic central neck dissection is still the subject of debate. The aim was to evaluate both the role and safety of prophylactic central neck dissection (CND) in managing pediatric papillary thyroid cancer (PTC), especially in respect of disease-free survival (DFS). Patients and Methods In this retrospective study, we collected 54 pediatric cN0 PTC patients (≤ 18 years of age) who were treated from January 2014 to January 2021 at a high-volume thyroid surgery center. Patients were divided into two groups based on the status of prophylactic CND. We analyzed the factors related to the clinicopathological features and recurrence of PTC in children. Results Of the 54 cN0 patients, 35 underwent prophylactic CND and 19 patients did not undergo prophylactic CND. The two groups were similar in clinical and pathologic features, such as age, gender, tumor size, multifocal status, and follow-up time. The average DFS was 84.4 ± 2.7 months. Log-rank tests on Kaplan-Meier curves revealed that age, gender, tumor size, multifocality, and extrathyroid extension did not relate to DFS time. Furthermore, DFS time was not affected by the extent of thyroidectomy (p=0.07) or RAI treatment (p=0.21). Prophylactic CND was found to increase DFS time for pediatric patients with cN0 PTC (p = 0.003). There was no statistically significant difference in complications such as transient hypocalcemia (p=0.15) and transient recurrent laryngeal nerve injury (p=0.37) between the prophylactic CND group and the no-prophylactic CND group. Conclusion Prophylactic CND was found to be associated with increased DFS and not with increased rates of complications after surgery.
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Affiliation(s)
- Duy Quoc Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
- *Correspondence: Duy Quoc Ngo,
| | - Duong The Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Quang Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
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Chen C, Hang L, Wu Y, Zhang Q, Zhang Y, Yang J, Xie J, Lu J. Retrospective analysis of clinical characteristics and risk factors of differentiated thyroid cancer in children. Front Pediatr 2022; 10:925538. [PMID: 36186657 PMCID: PMC9516328 DOI: 10.3389/fped.2022.925538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The incidence rate of children with thyroid cancer has an increasing trend. This study aimed to investigate the clinical characteristics and therapeutic approaches of differentiated thyroid cancer (DTC) in Chinese children. MATERIALS AND METHODS From January 1998 to March 2022, 52 cases undergoing surgical resection in Xinhua Hospital affiliated to Shanghai Jiao Tong University were divided by age (≤ 7 years old: n = 14 and 8-13 years old, n = 38). Treatment methods and clinical features were analyzed to evaluate prognostic factors for oncological outcomes. RESULTS Among the 52 cases, the proportion of local invasion in the pre-school group was found to be higher than that in the school-age group (p = 0.01). T stage was significantly different between the two groups (p ≤ 0.05); the proportion of T1-2 was higher in the school-age group (32 cases, 84.2%), while the proportion of T4 was higher in the pre-school group (6 cases, 42.8%) relatively. The postoperative complication rate was dramatically higher in pre-school children (p ≤ 0.05). Additionally, the total thyroidectomy rate in the non-recurrent group was slightly higher than that in the recurrent group (p ≤ 0.05). Over half of the recurrent cases had low T stage and low ATA (American Thyroid Association) risk levels at initial diagnosis (78.3 and 51.4%). CONCLUSION The local invasion, tumor stage, and recurrent laryngeal nerve (RLN) injury rates of the pre-school group were higher than that of the school-age group, where young age served as a potential hazard in DTC children. Hence, surgeons should emphasize high-risk features and optimize individualized surgical procedures for DTC children.
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Affiliation(s)
- Chun Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Lei Hang
- Tianhua College, Shanghai Normal University, Shanghai, China
| | - Yan Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Qing Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Yifei Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Jun Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Jin Xie
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Jingrong Lu
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
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Development and validation of a population-based model for predicting the regional lymph node metastasis in adolescent differentiated thyroid carcinoma. Oral Oncol 2021; 121:105507. [PMID: 34450454 DOI: 10.1016/j.oraloncology.2021.105507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adolescent differentiated thyroid carcinoma (DTC) is a rare type of thyroid cancer that represents a special entity of all endocrine-related cancer. This study aims to establish the first nomogram for predicting the regional (central and lateral) lymph node metastasis (LNM) in the adolescent population for better surgical management. METHOD We retrospectively reviewed the clinicopathology characteristics of adolescent patients with DTC in the Surveillance, Epidemiology, and End Results database between 2010 and 2015. RESULTS A total of 1,930 adolescent patients between the ages of 10 and 24 years from the SEER database were enrolled in this study. Six predictive factors including age, race, histology, multifocality, extrathyroidal invasion (EI) and tumor size were identified to be significantly associated with the regional LNM via univariate and multivariate logistic regression analyses. These indicators were used to construct a nomogram for predicting the regional LNM in adolescent patients with DTC. Moreover, a satisfied predictive ability of the model was determined with a C-index of 0.794, supported by an internal validation group with a C-index of 0.776. The Decision Curve Analysis and calibration curve further conducted a great agreement in our model. CONCLUSION The first predictive model containing multiple factors has been successfully established with good discrimination for predicting the regional LNM in adolescent patients with DTC. This nomogram could effectively help surgeons to make better individualized surgical decision intraoperatively, especially in terms of whether cervical lymph node dissection (LND) is warranted.
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Liang W, Sheng L, Zhou L, Ding C, Yao Z, Gao C, Zeng Q, Chen B. Risk Factors and Prediction Model for Lateral Lymph Node Metastasis of Papillary Thyroid Carcinoma in Children and Adolescents. Cancer Manag Res 2021; 13:1551-1558. [PMID: 33623434 PMCID: PMC7896733 DOI: 10.2147/cmar.s295420] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/29/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose Papillary thyroid carcinoma (PTC) in children and adolescents is prone to lateral lymph node metastasis (LNM), which is a high-risk factor for recurrence. However, few studies focused on identifying risk factors and establishing prediction models for lateral LNM of PTC in children and adolescents. Patients and Methods We retrospectively reviewed consecutive cases of children and adolescents with PTC undergoing thyroidectomy and cervical lymph node dissection between January 2009 and December 2019. The demographics and clinicopathologic features were collected and analyzed. Results A total of 102 children and adolescents with PTC were enrolled in our study; 51 of whom had lateral LNM (50%). After adjusting for other risk factors, the independent risk factors for lateral LNM were multifocality (odds ratio [OR]: 6.04; 95% confidence interval [CI]: 1.653–22.092; p=0.007), tumor size (OR: 1.752; 95% CI: 1.043–2.945; p=0.034), and the number of central LNM (OR: 1.23; 95% CI: 1.028–1.472; p=0.023). The formula of the combined predictor is: Multifocality + 0.31 × Tumor size + 0.115 × Number of central LNM. The area under the receiver operating characteristic curve of multifocality, tumor size, number of central LNM, and the combined predictor was 0.706, 0.762, 0.748, and 0.855, respectively. When the value of the combined predictor was ≥2.2744, lateral LNM could be predicted. The sensitivity and specificity of the predicted value were 82.4% and 74.5%, respectively. Conclusion The independent risk factors for lateral LNM in children and adolescents with PTC were multifocality, tumor size, and the number of central LNM. The prediction model can better predict the presence of lateral LNM.
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Affiliation(s)
- Weili Liang
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Lei Sheng
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Liguang Zhou
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Changyuan Ding
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Zhongyang Yao
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Chao Gao
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Qingdong Zeng
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Bo Chen
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
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Ngo DQ, Le DT, Hoang GN, Ngo QX, Le QV. Case Report: Transoral Endoscopic Thyroidectomy via Vestibular Approach in Pediatric Thyroid Cancer. Front Pediatr 2021; 9:765278. [PMID: 34765577 PMCID: PMC8576349 DOI: 10.3389/fped.2021.765278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is a new technique that has become more popular worldwide because of its many advantages. However, this novel approach for thyroid cancer treatment in children is highly challenging, even for high-volume surgeons. In our study, we report our experiences with TOETVA for pediatric patients with thyroid cancer. Patients and Methods: This study included four pediatric patients who underwent TOETVA performed by a single surgeon between June and December 2020. Patient demographics and surgical outcomes including operative time, incidence of complications, and length of hospital stay were evaluated. Results: Four patients successfully underwent TOETVA with no complications. All patients were girls, aged from 13 to 18. Three patients underwent lobectomy and isthmusectomy, plus prophylactic unilateral central neck dissection. One patient had a total thyroidectomy, plus prophylactic bilateral central neck dissection. The mean operative time was 85 min for the lobectomy and 120 min for total thyroidectomy plus central neck dissection. The median hospital stay was 4.1 days. No drains were used. The histological examination showed four cases of malignant disease (papillary thyroid carcinoma). The mean number of harvested lymph nodes was 4.2 (ranged 3 to 8). Conclusion: In the hands of a high-volume surgeon, TOETVA is a novel, feasible, and safe approach for treating selected pediatric patients with thyroid cancer.
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Affiliation(s)
- Duy Q Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Duong T Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Giap N Hoang
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Quy X Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Quang V Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam.,Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
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