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Trends and predictors of positive surgical margins in pediatric thyroid cancer

John J Ceremsak1, Rahul K Sharma1, Vivian L Weiss2

  • 1Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.

International Journal of Pediatric Otorhinolaryngology
|April 3, 2025
PubMed

Insights

Positive margin rates in pediatric thyroid cancer remained stable from 2004-2020. Younger age, male gender, and papillary histology predicted positive margins, which did not affect overall survival.

Area of Science:

  • Oncology
  • Pediatric Surgery
  • Surgical Pathology

Background:

  • Thyroid cancer is the most common endocrine malignancy in children and adolescents.
  • Positive surgical margins are a concern in thyroid cancer surgery, potentially impacting recurrence and survival.
  • Understanding trends and predictors of positive margins in pediatric thyroid cancer is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To analyze temporal trends in positive margin rates for pediatric thyroid cancer.
  • To identify patient, disease, and treatment-related predictors of positive margins in this population.
  • To evaluate the impact of margin status on overall survival in pediatric thyroid cancer.

Main Methods:

  • Retrospective analysis of the National Cancer Database (NCDB) from 2004 to 2020.
  • Inclusion of pediatric patients (≤18 years) diagnosed with thyroid cancer.
  • Calculation of positive margin rates by year; multivariable logistic regression for predictor analysis; survival analysis stratified by margin status.

Main Results:

  • A total of 6240 pediatric patients were included.
  • The overall positive margin rate was 15.5% and showed no significant change over time.
  • Younger age, male gender, total thyroidectomy, papillary histology, and positive lymph nodes were independently associated with positive margins.
  • Hospital volume was not a significant predictor of positive margins.
  • Margin status did not significantly impact overall survival.

Conclusions:

  • Positive margins in pediatric thyroid cancer are associated with specific patient and disease characteristics, including younger age, male gender, total thyroidectomy, lymph node metastasis, and papillary histology.
  • Hospital volume does not appear to influence the rate of positive margins.
  • Surgical margin status does not affect the overall survival of pediatric patients with thyroid cancer.
Abstract

Keywords:
Pediatric thyroid cancerPositive surgical margins

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