Impact of extent of surgery on survival for papillary thyroid cancer patients younger than 45 years

Mohamed Abdelgadir Adam, John Pura, Paolo Goffredo, Michaela A. Dinan, Terry Hyslop, Shelby D. Reed, Randall P. Scheri, Sanziana A. Roman, Julie A. Sosa

Research output: Contribution to journalArticlepeer-review

86 Scopus citations

Abstract

Context: Papillary thyroid cancer (PTC) patients <45 years old are considered to have an excellent prognosis; however, current guidelines recommend total thyroidectomy for PTC tumors 1.0 cm, regardless of age. Objective: Our objective was to examine the impact of extent of surgery on overall survival (OS) in patients <45 years old with stage I PTC of 1.1 to 4.0 cm. Design, Setting, and Patients: Adult patients <45 years of age undergoing surgery for stage I PTC were identified from the National Cancer Data Base (NCDB, 1998-2006) and the Surveillance, Epidemiology, and End Results dataset (SEER, 1988-2006). Main Outcome Measure: Multivariable modeling was used to compare OS for patients undergoing total thyroidectomy vs lobectomy. Results: In total, 29 522 patients in NCDB (3151 lobectomy, 26 371 total thyroidectomy) and 13 510 in SEER (1379 lobectomy, 12 131 total thyroidectomy) were included. Compared with patients undergoing lobectomy, patients having total thyroidectomy more often had extrathyroidal and lymph node disease. At 14 years, unadjusted OS was equivalent between total thyroidectomy and lobectomy in both databases. After adjustment, OS was similar for total thyroidectomy compared with lobectomy across all patients with tumors of 1.1 to 4.0 cm (NCDB: hazard ratio = 1.45 [confidence interval = 0.88-2.51], P = 0.19; SEER: 0.95 (0.70 -1.29), P = 0.75) and when stratified by tumor size: 1.1 to 2.0 cm (NCDB: 1.12 [0.50 -2.51], P=0.78; SEER: 0.95 [0.56 -1.62], P=0.86) and 2.1 to 4.0 cm (NCDB: 1.93 [0.88-4.23], P = 0.10; SEER: 0.94 [0.60 -1.49], P = 0.80). Conclusions: After adjusting for patient and clinical characteristics, total thyroidectomy compared with thyroid lobectomy was not associated with improved survival for patients <45 years of age with stage I PTC of 1.1 to 4.0 cm. Additional clinical and pathologic factors should be considered when choosing extent of resection.

Original languageEnglish (US)
Pages (from-to)115-121
Number of pages7
JournalJournal of Clinical Endocrinology and Metabolism
Volume100
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2015 by the Endocrine Society.

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