Total thyroidectomy does not improve survival for all patients with unilateral papillary thyroid cancer exceeding 4 cm

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-05-07 DOI:10.1016/j.amjsurg.2025.116395

Ying Ding , Ziyang Feng , Ke Cao

{"title":"Total thyroidectomy does not improve survival for all patients with unilateral papillary thyroid cancer exceeding 4 cm","authors":"Ying Ding , Ziyang Feng , Ke Cao","doi":"10.1016/j.amjsurg.2025.116395","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Total thyroidectomy (TT) is recommended for papillary thyroid cancer (PTC) over 4 cm, but its universal benefit is uncertain. This study evaluates whether TT offers a significant advantage over lobectomy (LT) in improving overall survival (OS) and cancer-specific survival (CSS) for patients with unilateral PTC exceeding 4 cm.</div></div><div><h3>Methods</h3><div>The study included 8862 patients from the Surveillance, Epidemiology, and End Results (SEER) database (2004–2021) with unilateral PTC larger than 4 cm. The relationship between age and survival was assessed using the restricted cubic splines (RCS) model. The effects of LT and TT on OS and CSS across age groups were analyzed using Cox regression and Kaplan-Meier (KM) methods, with and without age stratification. Propensity score matching (PSM) and sensitivity analyses were conducted to assess the robustness of the results.</div></div><div><h3>Results</h3><div>TT did not improve OS (<em>P</em> = 0.888) or CSS (<em>P</em> = 0.907) compared to LT in the overall cohort. However, TT significantly improved OS (HR = 0.54, <em>P</em> = 0.004) and CSS (HR = 0.55, <em>P</em> = 0.018) in high-risk patients (T4, N1, or M1 stage), but not in low-risk patients. Age-stratified analysis showed TT benefited only young (18–55 years) high-risk patients, enhancing OS (HR = 0.29, <em>P</em> = 0.001) and CSS (HR = 0.35, <em>P</em> = 0.035). Older patients did not gain significant survival advantages from TT, regardless of risk status. These results were consistent in the PSM and sensitivity analyses.</div></div><div><h3>Conclusions</h3><div>TT may not be the best approach for all unilateral PTC patients over 4 cm in terms of OS and CSS. It improves survival outcomes in young patients with advanced TNM stages but does not confer a significant OS or CSS advantage over LT for older or low-risk patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116395"},"PeriodicalIF":2.7000,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S000296102500217X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Total thyroidectomy (TT) is recommended for papillary thyroid cancer (PTC) over 4 cm, but its universal benefit is uncertain. This study evaluates whether TT offers a significant advantage over lobectomy (LT) in improving overall survival (OS) and cancer-specific survival (CSS) for patients with unilateral PTC exceeding 4 cm.

Methods

The study included 8862 patients from the Surveillance, Epidemiology, and End Results (SEER) database (2004–2021) with unilateral PTC larger than 4 cm. The relationship between age and survival was assessed using the restricted cubic splines (RCS) model. The effects of LT and TT on OS and CSS across age groups were analyzed using Cox regression and Kaplan-Meier (KM) methods, with and without age stratification. Propensity score matching (PSM) and sensitivity analyses were conducted to assess the robustness of the results.

Results

TT did not improve OS (P = 0.888) or CSS (P = 0.907) compared to LT in the overall cohort. However, TT significantly improved OS (HR = 0.54, P = 0.004) and CSS (HR = 0.55, P = 0.018) in high-risk patients (T4, N1, or M1 stage), but not in low-risk patients. Age-stratified analysis showed TT benefited only young (18–55 years) high-risk patients, enhancing OS (HR = 0.29, P = 0.001) and CSS (HR = 0.35, P = 0.035). Older patients did not gain significant survival advantages from TT, regardless of risk status. These results were consistent in the PSM and sensitivity analyses.

Conclusions

TT may not be the best approach for all unilateral PTC patients over 4 cm in terms of OS and CSS. It improves survival outcomes in young patients with advanced TNM stages but does not confer a significant OS or CSS advantage over LT for older or low-risk patients.

查看原文本刊更多论文

甲状腺全切除术并不能提高所有单侧甲状腺乳头状癌超过4厘米患者的生存率

背景：对于超过4cm的乳头状甲状腺癌（PTC），建议行甲状腺全切除术（TT），但其普遍疗效尚不确定。本研究评估TT在改善单侧PTC超过4 cm患者的总生存期（OS）和癌症特异性生存期（CSS）方面是否比肺叶切除术（LT）有显著优势。方法该研究纳入了来自监测、流行病学和最终结果（SEER）数据库（2004-2021）的8862例单侧PTC大于4cm的患者。使用限制性三次样条（RCS）模型评估年龄与生存率之间的关系。采用Cox回归和Kaplan-Meier （KM）方法分析有无年龄分层的LT和TT对各年龄组OS和CSS的影响。采用倾向评分匹配（PSM）和敏感性分析来评估结果的稳健性。结果在整个队列中，与LT相比，stt没有改善OS （P = 0.888）或CSS （P = 0.907）。然而，TT可显著改善高危患者（T4期、N1期和M1期）的OS （HR = 0.54, P = 0.004）和CSS (HR = 0.55, P = 0.018)，而对低危患者无显著改善。年龄分层分析显示，TT仅有利于年轻（18-55岁）高危患者，提高了OS （HR = 0.29, P = 0.001）和CSS （HR = 0.35, P = 0.035）。无论风险状况如何，老年患者没有从TT中获得显著的生存优势。这些结果在PSM和敏感性分析中是一致的。结论在OS和CSS方面，stt可能不是所有超过4 cm的单侧PTC患者的最佳方法。它改善了年轻晚期TNM患者的生存结果，但与老年或低风险患者相比，它没有显著的OS或CSS优势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.