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Thyroid lobectomy is not sufficient for T2 papillary thyroid cancers

Published:February 07, 2018DOI:https://doi.org/10.1016/j.surg.2017.12.026

      Abstract

      Background

      Histologic subtypes of papillary thyroid cancer affect prognosis. The objective of this study was to examine whether survival is affected by extent of surgery for conventional versus follicular-variant papillary thyroid cancer when stratified by tumor size.

      Methods

      Using the National Cancer Data Base, we evaluated 33,816 adults undergoing surgery for papillary thyroid cancer from 2004 to 2008 for 1.0-3.9 cm tumors and clinically negative lymph nodes. Conventional and follicular-variant papillary thyroid cancers were divided into separate groups. Cox regression models stratified by tumor size were used to determine if extent of surgery affected overall survival.

      Results

      A total of 30,981 patients had total thyroidectomy and 2,835 had thyroid lobectomy; 22,899 patients had conventional papillary thyroid cancer and 10,918 had follicular-variant papillary thyroid cancer. On unadjusted KM analysis, total thyroidectomy was associated with improved survival for conventional (P = 0.02) but not for follicular-variant papillary thyroid cancer patients (P = 0.42). For conventional papillary thyroid cancer, adjusted analysis showed total thyroidectomy was associated with improved survival for 2.0-3.9 cm tumors (P = 0.03) but not for 1.0-1.9 cm tumors (P = 0.16). For follicular-variant, lobectomy and total thyroidectomy had equivalent survival for 1.0-1.9 cm (P = 0.45) and 2.0-3.9 cm (P = 0.88) tumors.

      Conclusion

      Tumor size, histologic subtype, and surgical therapy are important factors in papillary thyroid cancer survival. Total thyroidectomy was associated with improved survival in patients with 2.0-3.9 cm conventional papillary thyroid cancer, and should be considered for 2.0-3.9 cm papillary thyroid cancers when preoperative molecular analysis is not used to distinguish conventional from follicular-variant.
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      References

        • American Cancer Society
        Cancer facts, figures.
        • Siegel R.
        • Naishadham D.
        • Jemal A.
        Cancer statistics, 2012.
        CA Cancer J Clin. 2012; 62: 10-29
        • Shi X.
        • Liu R.
        • Basolo F.
        • et al.
        Differential clinicopathological risk and prognosis of major papillary thyroid cancer variants.
        J Clin Endocrinol Metab. 2016; 101: 264-274
        • Haugen B.R.
        • Alexander E.K.
        • Bible K.C.
        • et al.
        2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer.
        Thyroid. 2015; 26: 1-133
        • Adam M.A.
        • Pura J.
        • Gu L.
        • et al.
        Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients.
        Ann Surg. 2014; 260 (discussion 605-7): 601-605
        • Bilimoria K.Y.
        • Bentrem D.J.
        • Ko C.Y.
        • et al.
        Extent of surgery affects survival for papillary thyroid cancer.
        Ann Surg. 2007; 246 (discussion 381-4): 375-381
        • Raval M.V.
        • Bilimoria K.Y.
        • Stewart A.K.
        • Bentrem D.J.
        • Ko C.Y.
        Using the NCDB for cancer care improvement: an introduction to available quality assessment tools.
        J Surg Oncol. 2009; 99: 488-490
        • National Cancer Institute
        Surveillance, epidemiology, and end results program. ICD-O-3 Coding Materials. ICD-O-3 SEER Site/histology validation list.
        • Lloyd R.V.
        • Buehler D.
        • Khanafshar E.
        Papillary thyroid carcinoma variants.
        Head Neck Pathol. 2011; 5: 51-56
        • Shaha A.R.
        Extent of surgery for papillary thyroid carcinoma: the debate continues: comment on “surgery for papillary thyroid carcinoma”.
        Arch Otolaryngol Head Neck Surg. 2010; 136: 1061-1063
        • Deyo R.A.
        • Cherkin D.C.
        • Ciol M.A.
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
        J Clin Epidemiol. 1992; 45: 613-619
        • DeGroot L.J.
        • Kaplan E.L.
        • McCormick M.
        • Straus F.H.
        Natural history, treatment, and course of papillary thyroid carcinoma.
        J Clin Endocrinol Metab. 1990; 71: 414-424
        • Kebebew E.
        • Clark O.H.
        Differentiated thyroid cancer: “complete” rational approach.
        World J Surg. 2000; 24: 942-951
        • Yu X.-M.
        • Schneider D.F.
        • Leverson G.
        • Chen H.
        • Sippel R.S.
        Follicular variant of papillary thyroid carcinoma is a unique clinical entity: a population-based study of 10,740 cases.
        Thyroid. 2013; 23: 1263-1268
        • Lam A.K.
        • Lo C.Y.
        • Lam K.S.
        Papillary carcinoma of thyroid: a 30-yr clinicopathological review of the histological variants.
        Endocr Pathol. 2005; 16: 323-330
        • Carcangiu M.L.
        • Zampi G.
        • Pupi A.
        • Castagnoli A.
        • Rosai J.
        Papillary carcinoma of the thyroid. A clinicopathologic study of 241 cases treated at the University of Florence, Italy.
        Cancer. 1985; 55: 805-828
        • Tielens E.T.
        • Sherman S.I.
        • Hruban R.H.
        • Ladenson P.W.
        Follicular variant of papillary thyroid carcinoma. A clinicopathologic study.
        Cancer. 1994; 73: 424-431
        • Sebastian S.O.
        • Gonzalez J.M.
        • Paricio P.P.
        • et al.
        Papillary thyroid carcinoma: prognostic index for survival including the histological variety.
        Arch Surg. 2000; 135: 272-277
        • Zidan J.
        • Karen D.
        • Stein M.
        • Rosenblatt E.
        • Basher W.
        • Kuten A.
        Pure versus follicular variant of papillary thyroid carcinoma: clinical features, prognostic factors, treatment, and survival.
        Cancer. 2003; 97: 1181-1185
        • Cooper D.S.
        • Doherty G.M.
        • Haugen B.R.
        • et al.
        Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer.
        Thyroid. 2009; 19: 1167-1214
        • Passler C.
        • Prager G.
        • Scheuba C.
        • et al.
        Follicular variant of papillary thyroid carcinoma: a long-term follow-up.
        Arch Surg. 2003; 138: 1362-1366
        • Lee S.R.
        • Jung C.K.
        • Kim T.E.
        • et al.
        Molecular genotyping of follicular variant of papillary thyroid carcinoma correlates with diagnostic category of fine-needle aspiration cytology: values of RAS mutation testing.
        Thyroid. 2013; 23: 1416-1422
        • Park J.Y.
        • Kim W.Y.
        • Hwang T.S.
        • et al.
        BRAF and RAS mutations in follicular variants of papillary thyroid carcinoma.
        Endocr Pathol. 2013; 24: 69-76
        • Yip L.
        • Wharry L.I.
        • Armstrong M.J.
        • et al.
        A clinical algorithm for fine-needle aspiration molecular testing effectively guides the appropriate extent of initial thyroidectomy.
        Ann Surg. 2014; 260: 163-168
        • Black W.C.
        • Haggstrom D.A.
        • Welch H.G.
        All-cause mortality in randomized trials of cancer screening.
        J Natl Cancer Inst. 2002; 94: 167-173
        • Nikiforov Y.E.
        • Seethala R.R.
        • Tallini G.
        • et al.
        Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors.
        JAMA Oncol. 2016; 2: 1023-1029