Cargando…

Extent of Surgery and the Prognosis of Unilateral Papillary Thyroid Microcarcinoma

It remains controversial whether patients with papillary thyroid microcarcinoma (PTMC) benefit from total thyroidectomy (TT) or thyroid lobectomy (TL). We aimed to investigate the impact of extent of surgery on the prognosis of patients with unilateral PTMC. Patients were obtained from the Surveilla...

Descripción completa

Detalles Bibliográficos
Autores principales: Zhao, Hengqiang, Cui, Le
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242954/
https://www.ncbi.nlm.nih.gov/pubmed/34220708
http://dx.doi.org/10.3389/fendo.2021.655608
_version_ 1783715670746202112
author Zhao, Hengqiang
Cui, Le
author_facet Zhao, Hengqiang
Cui, Le
author_sort Zhao, Hengqiang
collection PubMed
description It remains controversial whether patients with papillary thyroid microcarcinoma (PTMC) benefit from total thyroidectomy (TT) or thyroid lobectomy (TL). We aimed to investigate the impact of extent of surgery on the prognosis of patients with unilateral PTMC. Patients were obtained from the Surveillance, Epidemiology, and End Results database from 2004 to 2015. Cancer-specific survival (CSS) and overall survival (OS) were evaluated by Cox regression and Kaplan–Meier curves with propensity score matching. Of 31167 PTMC patients enrolled, 22.2% and 77.8% of which underwent TL and TT, respectively. Patients with TT were more likely to be younger, females, present tumors of multifocality, extrathyroidal extension, cervical lymph node metastasis (CLNM), distant metastasis, and receive radioactive iodine (RAI) compared with those receiving TL. The multivariate Cox regression model showed that TT was not associated with an improved CSS and OS compared with TL with hazard ratio (HR) and 95% confidence interval (CI) of 0.53 (0.25-1.12) and 0.86 (0.72-1.04), respectively. In addition, the Kaplan–Meier curves further confirmed the similar survival between TL and TT after propensity score matching. The subgroup analysis showed that TT was associated with better CSS for patients < 55 years, those with tumors of gross extrathyroidal extension, CLNM (N1b), and cases not receiving RAI with HR 95% CI of 0.13 (0.02-0.81), 0.12 (0.02-0.66), 0.11 (0.02-0.64) and 0.36 (0.13-0.90), respectively. TT predicted a trend of better OS for patients with N1b and distant metastasis after adjustment. In addition, TT was associated with better CSS than TL for patients with risk factors like N1b combined with gross extrathyroidal extension, and/or multifocality after matching. In conclusion, TL may be enough for low-risk PTMC patients. TT may improve the prognosis of unilateral PTMC patients with 2 or more risk clinicopathologic factors like CLNM, multifocality, extrathyroidal extension and a younger age compared with TL.
format Online
Article
Text
id pubmed-8242954
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-82429542021-07-01 Extent of Surgery and the Prognosis of Unilateral Papillary Thyroid Microcarcinoma Zhao, Hengqiang Cui, Le Front Endocrinol (Lausanne) Endocrinology It remains controversial whether patients with papillary thyroid microcarcinoma (PTMC) benefit from total thyroidectomy (TT) or thyroid lobectomy (TL). We aimed to investigate the impact of extent of surgery on the prognosis of patients with unilateral PTMC. Patients were obtained from the Surveillance, Epidemiology, and End Results database from 2004 to 2015. Cancer-specific survival (CSS) and overall survival (OS) were evaluated by Cox regression and Kaplan–Meier curves with propensity score matching. Of 31167 PTMC patients enrolled, 22.2% and 77.8% of which underwent TL and TT, respectively. Patients with TT were more likely to be younger, females, present tumors of multifocality, extrathyroidal extension, cervical lymph node metastasis (CLNM), distant metastasis, and receive radioactive iodine (RAI) compared with those receiving TL. The multivariate Cox regression model showed that TT was not associated with an improved CSS and OS compared with TL with hazard ratio (HR) and 95% confidence interval (CI) of 0.53 (0.25-1.12) and 0.86 (0.72-1.04), respectively. In addition, the Kaplan–Meier curves further confirmed the similar survival between TL and TT after propensity score matching. The subgroup analysis showed that TT was associated with better CSS for patients < 55 years, those with tumors of gross extrathyroidal extension, CLNM (N1b), and cases not receiving RAI with HR 95% CI of 0.13 (0.02-0.81), 0.12 (0.02-0.66), 0.11 (0.02-0.64) and 0.36 (0.13-0.90), respectively. TT predicted a trend of better OS for patients with N1b and distant metastasis after adjustment. In addition, TT was associated with better CSS than TL for patients with risk factors like N1b combined with gross extrathyroidal extension, and/or multifocality after matching. In conclusion, TL may be enough for low-risk PTMC patients. TT may improve the prognosis of unilateral PTMC patients with 2 or more risk clinicopathologic factors like CLNM, multifocality, extrathyroidal extension and a younger age compared with TL. Frontiers Media S.A. 2021-06-16 /pmc/articles/PMC8242954/ /pubmed/34220708 http://dx.doi.org/10.3389/fendo.2021.655608 Text en Copyright © 2021 Zhao and Cui https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Zhao, Hengqiang
Cui, Le
Extent of Surgery and the Prognosis of Unilateral Papillary Thyroid Microcarcinoma
title Extent of Surgery and the Prognosis of Unilateral Papillary Thyroid Microcarcinoma
title_full Extent of Surgery and the Prognosis of Unilateral Papillary Thyroid Microcarcinoma
title_fullStr Extent of Surgery and the Prognosis of Unilateral Papillary Thyroid Microcarcinoma
title_full_unstemmed Extent of Surgery and the Prognosis of Unilateral Papillary Thyroid Microcarcinoma
title_short Extent of Surgery and the Prognosis of Unilateral Papillary Thyroid Microcarcinoma
title_sort extent of surgery and the prognosis of unilateral papillary thyroid microcarcinoma
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242954/
https://www.ncbi.nlm.nih.gov/pubmed/34220708
http://dx.doi.org/10.3389/fendo.2021.655608
work_keys_str_mv AT zhaohengqiang extentofsurgeryandtheprognosisofunilateralpapillarythyroidmicrocarcinoma
AT cuile extentofsurgeryandtheprognosisofunilateralpapillarythyroidmicrocarcinoma