Pediatric Thyroid Cancer: An Update from the SEER Database 2007-2012

Abstract Objective To update the medical literature regarding the incidence, disease specific survival, and treatment modalities utilized in pediatric patients diagnosed with thyroid carcinomas. Study Design Cross Sectional Analysis of a National Database. Study Setting SEER Database. Methods The National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) Database was queried for all cases of pediatric thyroid cancer between the years 2007 and 2012. Patients ages 0-19 were grouped by histological subtypes and demographic data, overall incidence rate, and disease specific survival after surgery and surgery with radiation therapy. Fifteen-Year Disease Specific Survival Curves were generated and treatment modalities were compared to assess for statistical differences at each yearly interval. Results A total of 1723 pediatric patients were identified and the average age-adjusted rate of malignancy was determined to be 0.59 per 100,000 patients. The incidence of pediatric thyroid cancer was approximately 4.4:1 when comparing females to males, respectively. Papillary subtype was the most common (n=1014, 58.8%), followed by follicular variant subtype (n=397, 23%), follicular subtype (n=173, 10.1%) and medullary subtype (n=139, 8.1%). As pediatric patients reached fifteen to nineteen years of age, the incidence of papillary and follicular variant subtypes increased. Analysis of medullary thyroid cancer data revealed that incidence was highest in the zero to four age group and declined at later years. Pediatric patients presenting with metastatic medullary thyroid carcinoma maintained significantly poorer fifteen-year disease specific survival when compared to other histologic subtypes (p < 0.05). Intervention with surgery and radiation therapy provided significant benefit across all histologic subtypes when evaluating disease specific survival at fifteen-years past the initial diagnoses (p < 0.05). Conclusions Pediatric thyroid carcinoma remains an uncommon diagnosis despite an annual increase in incidence of approximately one percent since the development of the SEER database. Overall, pediatric thyroid carcinomas demonstrate an excellent prognosis if identified early and appropriate management is available. Caucasian female patients have higher incidence of carcinoma diagnoses when compared to males. Medullary histologic subtype, especially when metastatic at initial diagnoses, demonstrates statistically poorer outcomes when compared to other su