Elsevier

Surgery

Volume 154, Issue 3, September 2013, Pages 429-435
Surgery

Surgical Outcome Research
MeSS: A novel prognostic scale specific for pediatric well-differentiated thyroid cancer: A population-based, SEER outcomes study

https://doi.org/10.1016/j.surg.2013.04.047Get rights and content

Background

High-risk prognostic factors for adults with well-differentiated thyroid cancer (WDTC) have been well established, but the same is not true for pediatric patients. This study sought to determine whether validated adult prognostic systems are applicable to pediatric patients and to develop a novel prognostic scale that may better reflect outcomes in pediatric subgroups.

Methods

We queried 62,007 cases of WDTC from the Surveillance, Epidemiology, and End Results (SEER) database (1973–2009) to identify 895 patients <20 years of age with WDTC. Data abstracted included age, gender, race, histology type, primary tumor size, cancer stage, and mortality. Odds ratio and 95% confidence intervals were set and data were analyzed with SAS version 9.2.

Results

Among 895 pediatric WDTC patients, the overall cause-specific mortality was 0.8%. The presence of distant metastasis was associated with the worst prognosis (P = .0045) followed by larger primary tumor size (P = .0135) and male gender (P = .0162). When classified into low-, moderate-, and high-risk categories according to the distant metastasis (Me), larger primary tumor size (S), and male sex (S) (MeSS) algorithm, mortality rates were 0%, 2.7%, and 23%, respectively.

Conclusion

Commonly used prognostic indices for WDTC in adults do not reliably predict poor outcomes among pediatric patients. Rather, a system based on MeSS is more applicable to pediatric patients. Patients who exhibit a high MeSS score have a significantly worse overall survival than those who do not express any MeSS characteristics.

Section snippets

Methods

This study represents a retrospective, cohort study of patients diagnosed with WDTC under the age of 20 years. Patient information was acquired from the SEER database from the National Cancer Institute. The SEER database registers patient data without personal identifiers from a population of approximately 30 million people across specified geographic locations in the United States.2 Medullary or poorly differentiated types of thyroid cancer do not fall under the category of WDTC and,

Results

The patient population in the study had a male to female ratio of 1:4.7 with a median age of 17 years. Seven patients out of the 895 died of causes relating directly to WDTC (0.8%) with an average survival of 3.9 months. The most prevalent patient characteristics in the study were age 15–19 years (76%), female (82%), and Caucasian race (72%). Additionally, the most common tumor characteristics were papillary histology (65%), primary tumor size ≥1 and <4 cm (40%), and regionally invasive (47%)

Discussion

In general, WDTC has an excellent prognosis, especially among the pediatric population. Nonetheless, it is of great importance to identify high-risk patients at the time of diagnosis. Cancer staging and risk assessment are essential aspects of patient management. These not only provide accurate prognostic information for the patient and physician, but also help govern the degree of aggressive treatment necessary for each individual. The objective of this study was to develop a novel algorithm

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