Surgery for papillary thyroid carcinoma: is lobectomy enough?

Abstract

Objective: To further understanding of treatment of papillary thyroid carcinoma (PTC).

Design: The Surveillance, Epidemiology, and End Results Program database was searched for patients who had undergone surgery for PTC.

Setting: Areas covered by Surveillance, Epidemiology, and End Results population-based registries.

Patients: Patients who had undergone PTC surgery between January 1, 1988, and December 31, 2001, were included in the study.

Main outcome measures: Disease-specific survival (DSS) and overall survival (OS).

Results: Of the total 22,724 patients with PTC, 5964 patients underwent lobectomy. There were 2138 total and 471 disease-specific deaths. Controlling for tumor size, multivariate analysis revealed no survival difference between patients who had undergone total thyroidectomy and those who had undergone lobectomy. Increased tumor size, extrathyroidal extent, positive nodal status, and increased age displayed significantly worse DSS and OS (P < .001). Histologically, follicular PTC subtype did not affect DSS or OS. Patients who had received radioactive iodine had poorer DSS but improved OS. Patients undergoing external beam radiation therapy had poor DSS (hazard ratio, 4.48; 95% confidence interval, 3.30-6.06; P < .001) and OS (1.71; 1.42-2.07; P < .001).

Conclusions: The results of this study compel us to reinvestigate the current PTC surgical recommendations of total thyroidectomy based on tumor size because this may not affect survival across all populations. In addition, the current use of external beam radiation therapy for the treatment of PTC should be reexamined.