Hyun-Soo Zhang1, Eun-Kyung Lee2, Yuh-Seog Jung3, Byung-Ho Nam4, Kyu-Won Jung5, Hyun-Joo Kong5, Young-Joo Won6, Boyoung Park7. 1. Department of Medicine, College of Medicine, Hanyang University, Seoul, Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea. 2. Center for Thyroid Cancer, Head and Neck Oncology Clinic, National Cancer Center, Goyang, Korea. 3. Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea; Center for Thyroid Cancer, Head and Neck Oncology Clinic, National Cancer Center, Goyang, Korea. 4. Herings, Institute of Advanced Clinical and Biomedical Research, Seoul, Korea. 5. National Cancer Control Institute, National Cancer Center, Goyang, Korea. 6. Center for Thyroid Cancer, Head and Neck Oncology Clinic, National Cancer Center, Goyang, Korea; National Cancer Control Institute, National Cancer Center, Goyang, Korea. 7. Department of Medicine, College of Medicine, Hanyang University, Seoul, Korea. Electronic address: hayejine@hanmail.net.
Abstract
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.
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 cancerpatients 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 cancerpatients 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 cancerpatients except in a specific high-risk group. 80% or more of low-risk papillary thyroid cancerpatients received a total thyroidectomy. These results suggest that further patient-centered treatment which considers both quality of life and clinical outcome is needed.