L. M. Youngwirth1, M. A. Adam1, S. M. Thomas1, R. P. Scheri1, S. A. Roman1, J. A. Sosa1 1Duke University Medical Center,Durham, NC, USA
Introduction: Papillary thyroid cancer is the most common endocrine malignancy in children, but it is still rare. Therefore, data are limited on patient outcomes. This study sought to determine pediatric papillary thyroid cancer patient outcomes by facility case volume on a national level.
Methods: The National Cancer Data Base (1998-2011) was queried for all pediatric patients (age ≤18) with papillary thyroid cancer. Demographic, clinical, and pathologic features at the time of diagnosis were evaluated for all patients. Facility case volume was defined as the total number of pediatric thyroid cancer patients presenting at a given hospital, and case volume quartiles were created that contained an approximately equal number of facilities. Patients then were placed into quartiles based on these case volume definitions. Univariate analysis was performed to measure association with outcomes, including length of stay and readmissions.
Results: In total, 3,809 patients met inclusion criteria. The majority were female (80.2%) and white (89.2%). The mean tumor size was 2.6 ± 2.9 cm, and 49.7% of patients had metastatic disease in cervical lymph nodes. The majority of patients underwent total thyroidectomy (88.7%) and received radioactive iodine (59.7%). The five year overall survival was 99.0%. Patients treated at the highest volume facilities were younger (mean age of 14.8 years vs 16.0 years), more likely to be treated at an academic facility (71.7% vs 3.0%), and more likely to travel a greater distance to their treatment facility (mean distance of 50.1 vs 13.8 miles) (all p <0.01). Also, patients treated at the highest volume facilities were more likely to undergo total thyroidectomy (91.0% vs 81.5%) and receive radioactive iodine (63.1% vs 54.2%) (all p <0.01). The mean length of stay was similar in all quartiles (p =0.71); however, patients treated at the highest volume facilities were less likely to be readmitted than patients treated at the lowest volume facilities (5.2% vs 9.0%; p <0.01).
Conclusion: Pediatric patients with papillary thyroid cancer treated at low volume centers were more likely to be readmitted after thyroid surgery than patients treated at high volume centers. Providers should consider facility case volume status when referring these children for thyroid surgery.