Background
Papillary thyroid cancer has an excellent prognosis, but the appropriate level of
treatment is controversial. We compared survival between total thyroidectomy and less-than-total
thyroidectomy, and examined the proportion of patients with papillary thyroid cancer
in Korea undergoing total thyroidectomy.
Methods
A nationwide sample of 5,230 papillary thyroid cancer patients was included (total
thyroidectomy: 4,262, less-than-total thyroidectomy: 968). Using multivariate Cox
regression, we compared overall survival and cause-specific survival by the extent
of thyroidectomy (total thyroidectomy versus less-than-total thyroidectomy) for a
1:1 optimal match via the propensity score and for the total study population. We
also compared overall survival by extent of thyroidectomy and the proportion of total
thyroidectomy in different risk groups using papillary thyroid cancer staging systems.
Results
We saw no difference in overall survival by extent of thyroidectomy in the propensity
score matched population and the total study population (hazard ratio for less-than-total
thyroidectomy 0.82, 95% confidence interval 0.52–1.29; hazard ratio for less-than-total
thyroidectomy 1.03, 95% confidence interval 0.71–1.48, respectively). Similarly, there
were no differences in thyroid cancer–specific survival by extent of thyroidectomy.
None of the different risk groups showed differences in overall survival by surgical
extent, although total thyroidectomy improved overall survival in older females with
larger tumors. The proportion of papillary thyroid cancer patients who received a
total thyroidectomy was 80% or greater regardless of risk group classification.
Conclusion
Total thyroidectomy had no survival advantage over less-than-total thyroidectomy in
Korean papillary thyroid cancer patients except in a specific high-risk group. 80%
or more of low-risk papillary thyroid cancer patients received a total thyroidectomy.
These results suggest that further patient-centered treatment which considers both
quality of life and clinical outcome is needed.
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Article info
Publication history
Published online: October 17, 2018
Accepted:
August 28,
2018
Received in revised form:
August 12,
2018
Received:
May 24,
2018
Footnotes
Supported by a research fund from Hanyang University, Seoul, Korea (Research No. HY-201800000000615).
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
