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The optimal surgical approach for papillary thyroid carcinoma with pathological n1 metastases: An analysis from the SEER database
Author(s) -
Ji Tingting,
Chen Jun,
Mou Jianing,
Ni Xin,
Guo Yongli,
Zhang Jie,
Wang Shengcai,
Wang Wei,
Zhang Xin,
Tai Jun
Publication year - 2020
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27947
Subject(s) - medicine , thyroid carcinoma , proportional hazards model , epidemiology , thyroidectomy , population , oncology , surveillance, epidemiology, and end results , pathological , thyroid cancer , database , carcinoma , thyroid , biopsy , cancer registry , environmental health , computer science
Objectives/Hypothesis The definition of large‐volume pathologic N1 metastases has been changed in the 2017 version 2 of the National Comprehensive Cancer Network guidelines, leading to a controversy over the optimal surgical approach selection for patients with biopsy‐proven papillary thyroid carcinoma (PTC). The aim of this study was to investigate the therapeutic efficacy of total thyroidectomy (TT) and thyroid lobectomy (TL) for these patients. Study Design Retrospective population‐based database analysis. Methods A total of 906 consecutive PTC patients with pathologic N1 metastases (>5 involved nodes with metastases ≤5 mm in the largest dimension) were retrieved from the Surveillance, Epidemiology, and End Results database, and divided into two groups (≤2 mm, >2–5 mm) based on the size of the extent of disease. Overall survival (OS) was then compared between patients treated with TT and TL, followed by Cox proportional hazards regression analysis to explore multiple prognostic factors. Results OS favored TT compared with TL in patients with more than five involved nodes and metastases >2 to 5 mm in the largest dimension ( P < .05). Cox analysis showed that the TL was not an independent factor associated with poorer OS than TT in these patients ( P > .05). Conclusions TT showed better survival than TL for patients with more than five involved nodes and metastases >2 to 5 mm in the largest dimension. For patients with more than five involved nodes and metastases ≤2 mm in the largest dimension, either TT or TL can be recommended because there was no difference in survival. Level of Evidence NA Laryngoscope , 130:269–273, 2020