Open AccessLong-term survival of patients with thyroid cancer according to the methods of tumor detection: A nationwide cohort study in Korea
Author(s) -
YuhSeog Jung,
ChangMo Oh,
Yeol Kim,
Kyu-Won Jung,
Junsun Ryu,
YoungJoo Won
Publication year - 2018
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0194743
Subject(s) - medicine , hazard ratio , propensity score matching , stage (stratigraphy) , thyroid cancer , follicular thyroid cancer , retrospective cohort study , proportional hazards model , cancer , cohort , survival analysis , oncology , papillary thyroid cancer , thyroid , gastroenterology , confidence interval , biology , paleontology
In this retrospective cohort study, we compared the survival of patients detected by screening with those detected based on symptoms, according to their tumor stages. After propensity score matching, 2,130 patients with papillary or follicular thyroid cancer, identified by screening detection (SD) and clinical detection (CD), were included. We compared the survival rates of patients identified by SD and CD in the early and advanced stages of thyroid cancer. Cox proportional hazard models were used to compare the hazard ratios (HRs) for mortality between the two groups. Of the 1,065 patients in each group, 12 (1.1%) died in the SD group, compared to 44 (4.1%) in the CD group, during an average 9.4 years ( p <0.001). For early stage, there was no significant difference in all-cause and thyroid cancer-specific mortality between the two groups ( p = 0.08, p = 0.0502). However, for advanced stage, the survival rates in the SD group were significantly higher than in the CD group ( p <0.001, p = 0.004). Moreover, after adjusting for covariates, the HRs of all-cause mortality of the SD group was significantly lower than that of the CD group for the advanced stage patients (HRs: 0.37 [95% CIs: 0.17–0.80]), while no significant difference was observed in the early stage. While screening for thyroid cancer was not beneficial for early stage patients, our findings suggest that detection via screening is associated with better survival for patients with advanced stage cancer. However, the effects of selection bias and lead time bias could not be entirely excluded.