(1010) Demographic Disparities in Pediatric Papillary Thyroid Carcinoma Surgical Management: Pre- and Post-2015 ATA Guideline Analysis

Introduction: Pediatric papillary thyroid carcinoma (PTC) frequently presents with more advanced disease than adult thyroid cancer, leading the 2015 American Thyroid Association (ATA) pediatric guidelines to recommend total thyroidectomy for the majority of patients. This study aims to assess how surgical demographic disparities and surgical de-escalation have changed after implementation of the 2015 ATA pediatric guidelines.

Methods: The National Cancer Database (NCDB) was queried from 2010–2021 (2010-2015 = Pre-ATA; 2016-2021= Post-ATA) for patients ≤18 years old with histologically confirmed PTC. Patients who did not receive either hemithyroidectomy or total thyroidectomy were excluded. Using IBM SPSS and GraphPad Prism, statistical analyses were conducted via variable frequencies and binomial regression models.

Results: A total of 3,331 patients were included, with 1,648 diagnosed in the pre-2015 ATA era and 1,683 in the post-2015 ATA era. 7% of the pre-ATA cohort underwent hemithyroidectomy and 93.0% underwent subtotal or total thyroidectomy, compared with 9.6% and 90.4%, respectively, in the post-ATA cohort. Black race was significantly associated with lower odds of hemithyroidectomy compared with White patients before and after the 2015 ATA (pre-ATA adjusted OR 0.36, p=0.005; post-ATA aOR 0.46, p=0.011). Hispanic ethnicity was associated with higher odds of having ≥1 positive lymph node in both the pre-ATA (aOR 1.93, p=0.001) and post-ATA eras (aOR 1.61, p=0.010). In the post-ATA era, patients age 16–18 years became associated with lower odds of lymph node positivity compared with younger patients (aOR 0.75, p=0.025), while greater distance traveled for care (10–50 miles) was also associated with reduced odds (aOR 0.75, p=0.042). Female patients were less likely to have a positive lymph node in the pre-ATA era (aOR 0.60, p=0.004), but not in the post-ATA era.

Conclusions: Despite increased standardization following the 2015 ATA pediatric guidelines, demographic disparities in surgical management and lymph node involvement persist, highlighting ongoing inequities in pediatric thyroid cancer care.