The role of surgery in small differentiated thyroid cancer

Introduction The incidence of small, differentiated thyroid cancer (DTC) cases has been increasing in the United States and the world mainly due to incidental detection because of widespread use of diagnostic modalities. While the option of active surveillance instead of surgical resection is getting more popular, there is still an open discussion about the best approach in these cases. Materials and methods The National Cancer Database was queried for patients diagnosed with non-metastatic small T1/N0 DTC between 2004 and 2016, who have known surgical status and Charlson comorbidity index of two or less. We evaluated the overall survival (OS) based on the surgery status using Kaplan–Meier estimates and multivariable cox regression analyses. Results A total of 98,501 patients with non-metastatic small DTC were included, within which 96,612 (98.1%) were treated with surgery, and 1889 (1.9%) were not treated with surgery or other ablative modalities. We found that patients who were treated with surgery had better OS compared to patients who were not treated with surgery (mean OS 171 months vs 134.1 months, P < 0.001, median OS was not reached). This difference was still statistically significant even after we used propensity score matching for age, gender, race, Charlson-Deyo score, tumor size, and histology. On multivariate analysis, surgery was associated with better OS (HR 0.218; 95% CI: 0.196–0.244; P < 0.001). Same trend was found in subgroup analysis when we split the cohort according to tumor size (<1 and ≥1 cm), histology (follicular, papillary and Hurthle cell carcinoma), and age (<55 years vs ≥55 years). Conclusion Patients with non-metastatic small DTC who were treated with surgery had significant improvement in OS compared to patients who were not treated with surgery. Notwithstanding the limitations of the current analysis, these results call for caution prior to recommending routine surveillance for all patients with small DTC..

Highlights Thyroid cancer is the most common endocrine malignancy.Thyroid cancer incidence rate is increasing, especially small thyroid tumors.The oncologic safety of active surveillance versus surgical resection in small, differentiated thyroid cancer is still controversial.Surgical resection improves the OS in small DTC.The survival benefit of surgical treatment is seen in all histologic types of DTC..

Medienart:	Artikel

Erscheinungsjahr:	2022
Erschienen:	2022

Enthalten in:	Zur Gesamtaufnahme - volume:77
Enthalten in:	EJE - 77(2022), 3 vom: 03. Juni, Seite 469-479

Sprache:	Englisch

Beteiligte Personen:	Baidoun, Firas [VerfasserIn] Abdel-Rahman, Omar [VerfasserIn]

Links:	Volltext [lizenzpflichtig]

Themen:	Active surveillance Overall survival Surgical resection Thyroid cancer

Anmerkungen:	© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022

doi:	10.1007/s12020-022-03097-6

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PPN (Katalog-ID):	OLC2079370022