Trends and predictors of positive surgical margins in pediatric thyroid cancer

Objective

To understand trends in positive margin rates in pediatric thyroid cancer over time and investigate predictors of positive margins.

Study design and setting

Retrospective analysis of deidentified National Cancer Database (NCDB) records from 2004 to 2020.

Methods

The study cohort included pediatric patients (age 18 or younger) with thyroid cancer with available records in the NCDB. The positive margin rate was calculated by year of diagnosis. Multivariable regression was used to assess for predictors of positive margins. Survival analysis was performed stratified by margin status.

Results

We identified 6240 patients who met inclusion criteria. The overall positive margin rate was 15.5 % and did not change significantly over the study period. Positive margins were independently associated with younger age, male gender, total thyroidectomy, papillary histology, and positive lymph node status on multivariable logistic regression models. Hospital volume was not a predictor of positive margin rate. Margin status did not impact overall survival.

Conclusion

Positive margins in pediatric thyroid cancer are more likely in younger patients, male patients, those undergoing total thyroidectomy, those with lymph node metastasis, and those with papillary thyroid carcinoma. Hospital volume is not associated with positive margin rate. Positive margins do not impact overall survival in this patient population.