Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Oct;260(4):601-5; discussion 605-7.
doi: 10.1097/SLA.0000000000000925.

Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients

Mohamed Abdelgadir Adam  1 , John Pura, Lin Gu, Michaela A Dinan, Douglas S Tyler, Shelby D Reed, Randall Scheri, Sanziana A Roman, Julie A Sosa
Affiliations

Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients

Mohamed Abdelgadir Adam et al. Ann Surg. 2014 Oct.

Abstract

Objective: To examine the association between the extent of surgery and overall survival in a large contemporary cohort of patients with papillary thyroid cancer (PTC).

Background: Guidelines recommend total thyroidectomy for PTC tumors >1 cm, based on older data demonstrating an overall survival advantage for total thyroidectomy over lobectomy.

Methods: Adult patients with PTC tumors 1.0-4.0 cm undergoing thyroidectomy in the National Cancer Database, 1998-2006, were included. Cox proportional hazards models were applied to measure the association between the extent of surgery and overall survival while adjusting for patient demographic and clinical factors, including comorbidities, extrathyroidal extension, multifocality, nodal and distant metastases, and radioactive iodine treatment.

Results: Among 61,775 PTC patients, 54,926 underwent total thyroidectomy and 6849 lobectomy. Compared with lobectomy, patients undergoing total thyroidectomy had more nodal (7% vs 27%), extrathyroidal (5% vs 16%), and multifocal disease (29% vs 44%) (all Ps < 0.001). Median follow-up was 82 months (range, 60-179 months). After multivariable adjustment, overall survival was similar in patients undergoing total thyroidectomy versus lobectomy for tumors 1.0-4.0 cm [hazard ratio (HR) = 0.96; 95% confidence interval (CI), 0.84-1.09); P = 0.54] and when stratified by tumor size: 1.0-2.0 cm [HR = 1.05; 95% CI, 0.88-1.26; P = 0.61] and 2.1-4.0 cm [HR = 0.89; 95% CI, 0.73-1.07; P = 0.21]. Older age, male sex, black race, lower income, tumor size, and presence of nodal or distant metastases were independently associated with compromised survival (P < 0.0001).

Conclusions: Current guidelines suggest total thyroidectomy for PTC tumors >1 cm. However, we did not observe a survival advantage associated with total thyroidectomy compared with lobectomy. These findings call into question whether tumor size should be an absolute indication for total thyroidectomy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Unadjusted overall survival for patients undergoing total thyroidectomy vs. lobectomy for PTC tumors 1.0–4.0 cm OS, overall survival PTC, papillary thyroid carcinoma
Figure 2
Figure 2
Unadjusted overall survival for patients with PTC tumors 1.0–2.0 cm vs. 2.1–4.0 cm OS, overall survival PTC, papillary thyroid carcinoma
See this image and copyright information in PMC

References

    1. American Cancer Society. [Accessed March 01, 2014];Cancer Facts & Figures. 2013 Available at: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/docume....
    1. Siegel R, DeSantis C, Virgo K, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62:220–241. - PubMed
    1. Davies L, Welch HG. Thyroid cancer survival in the United States: observational data from 1973 to 2005. Arch Otolaryngol Head Neck Surg. 2010;136:440–444. - PubMed
    1. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–1214. - PubMed
    1. Bilimoria KY, Bentrem DJ, Ko CY, et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007;246:375–381. discussion 381–384. - PMC - PubMed

MeSH terms