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Only and Autopsy Only
”
in order to prevent the inclusion of pa-
tients who would skew the disease speci
fi
c survival calculations.
Data was then combined for each of the pediatric thyroid subtypes
and standard error of the mean and 95% con
fi
dence intervals were
calculated. Disease speci
fi
c survival data points at each study in-
terval were compared using T-Test analysis to determine signi
fi
cant
difference between the treatment groups.
2.3.2. Statistical analysis calculations
Statistical analysis was performed utilizing the Minitab Inc.
software (State College, PA) to determine statistical differences
between treatment groups. Fifteen-Year Disease Speci
fi
c Survival
data was compared utilizing the Student's T test to determine
bene
fi
t of each treatment modality. The log rank test was not uti-
lized for statistical comparison because the disease speci
fi
c survival
curves do not re
fl
ect a patient's full life span from the point of
diagnosis, but rather illustrate survivorship at
fi
fteen years from the
time of initial diagnosis. The disease speci
fi
c survival calculations
were weighted similarly to prevent bias of survivorship within the
earlier or later time periods. Calculations were considered statis-
tically signi
fi
cant if P-values were less than 0.05 and 95% con
fi
-
dence intervals did not overlap between the two groups of interest.
3. Results
3.1. Patient cohort demographics
A total of 1723 pediatric patients were located in the SEER
Database and further strati
fi
ed based on age, sex, and ethnicity.
According to our analysis, teenage Caucasian females maintained
the highest frequency of obtaining a diagnosis of thyroid carcinoma
when evaluating rates per 100,000 patients. Furthermore, females
maintained an age-adjusted rate of diagnosis compared to males of
approximately 4.4:1 per 100,000 patients. Lastly, African Americans
and the unspeci
fi
ed cohorts demonstrated less frequent diagnoses
across each age group when compared to the Caucasian cohort
(
Table 1
).
3.2. Average age adjusted incidence rate of pediatric thyroid cancer
subtypes
The overall age adjusted average rate of pediatric thyroid cancer
from 2007 to 2012 was determined to be 0.59 new diagnoses per
100,000 individuals (see
Table 2
). When evaluating papillary thy-
roid carcinoma, follicular thyroid carcinoma, medullary thyroid
carcinoma, and papillary follicular carcinoma thyroid subtypes, the
average rates of incidence were determined to be: 0.30 (47.6%), 0.14
(23.8%), 0.05 (6.7%), and 0.13 (21.9%) per 100,000 reported patients,
regardless of age, respectively. Furthermore, papillary, follicular,
and papillary follicular variant became more prominent in terms of
frequency of diagnosis as pediatric patients reached the
fi
fteen to
nineteen age groups (
Fig. 1
). Medullary thyroid cancer was the most
frequent in terms of incidence in the zero to four years of age group,
but subsequently declined once the
fi
ve to nineteen years of age
group demographics were analyzed (
Fig. 1
).
3.3. Overall
fi
fteen year disease speci
fi
c survival of individuals
diagnosed with pediatric thyroid cancer
At
fi
fteen years post diagnosis, the disease speci
fi
c survival for
each age group, regardless of tumor subtype, demonstrated greater
than ninety percent survival. Speci
fi
cally, the younger de-
mographics, including the zero to four and
fi
ve to nine years of age
groups, maintained a
fi
fteen-year disease speci
fi
c survival of
approximately ninety-nine percent when surgery and radiation
therapy, radioactive iodine uptake or external beam therapy, were
utilized. Interestingly, patients who were diagnosed in the ten to
fourteen and
fi
fteen to nineteen age groups maintained excellent
survival outcomes, yet
fi
fteen-year disease speci
fi
c survival were
signi
fi
cantly lower compared to the two younger age groups
(p
<
0.05). Despite this statistically signi
fi
cant difference, the two
older cohorts still demonstrated a disease speci
fi
c survival greater
than 95% (
Fig. 2
).
3.4. Fifteen year disease speci
fi
c survival based on cancer subtype
and therapeutic intervention
Pediatric patients, regardless of age group, demonstrated
excellent
fi
fteen-year disease speci
fi
c survival after intervention
with surgery or surgery with adjuvant radiation, radioactive iodine
uptake or external beam therapy. Individuals demonstrated signif-
icantly improved survival outcomes if they underwent radiation
therapy in conjunction with their primary surgery management
regardless of tumor subtype (p
<
0.001). The
fi
fteen-year disease
Table 1
Demographics of pediatric patients diagnosed with papillary thyroid cancer as rate
per 100,000 patients from 2007 to 2012.
Age group
1
e
4
5
e
9
10
e
14 15
e
19
Sex
Male
0.001 0.04
0.11
0.31
Female
0.01
0.05
0.36
1.48
Ethnicity
Caucasian
0.01
0.08
0.38
0.27
African American 0.00
0.007 0.03
0.08
Unspeci
fi
ed
0.001 0.003 0.05
0.19
Table 2
Demographics of pediatric patients diagnosed with thyroid cancer.
Carcinoma subtype
Diagnosis count
Frequency of total
Papillary
1014
58.8
Papillary follicular variant
397
23.0
Follicular
173
10.1
Medullary
139
8.1
Fig. 1.
Incidence of pediatric thyroid carcinoma based on most frequent subtype per
100,000 as a percent of total cohort. (For interpretation of the references to colour in
this
fi
gure legend, the reader is referred to the web version of this article.)
S. Dermody et al. / International Journal of Pediatric Otorhinolaryngology 89 (2016) 121
e
126
167