Long-Term Survival After Thyroidectomy for Thyroid Cancer: A Propensity-Matched TriNetX Study with Specialty-Stratified Analyses.

Abstract

Background/objectives: Whether thyroidectomy confers a long-term survival advantage over non-surgical management in real-world practice remains uncertain. We primarily evaluated the association between surgery and all-cause mortality in thyroid cancer; specialty-stratified outcomes were prespecified as secondary, exploratory analyses.

Methods: Using the TriNetX US Collaborative Network (2008-2024), we identified adults with thyroid cancer and created 1:1 propensity score-matched cohorts of patients who did or did not undergo thyroidectomy, balancing demographics, comorbidities, medications, and laboratory variables. Overall survival was assessed with Kaplan-Meier curves and Cox proportional hazard models. Among the surgical patients, we performed exploratory analyses stratified by operating specialty (otolaryngology-head and neck surgery (reference) vs. general/endocrine surgery and other/unknown, reported descriptively).

Results: After matching, 49,219 patients were included per cohort. Thyroidectomy was associated with lower long-term mortality versus non-surgical care (adjusted HR 0.685, 95% CI 0.652-0.721). Among the surgical patients, secondary, exploratory specialty-stratified analyses suggested differences: compared with otolaryngology-head and neck surgery (ENT-HNS; reference), general/endocrine surgery (GS/ES) had a lower adjusted hazard of death (aHR 0.561, 95% CI 0.481-0.654), whereas other/unknown specialties had a higher adjusted hazard (aHR 1.583, 95% CI 1.302-1.924). These patterns are hypothesis-generating and may reflect residual confounding, including the tumor stage and histology, referral pathways, and surgeon or center experience.

Conclusions: In a large, propensity-matched real-world cohort, surgery was linked to improved long-term survival regarding thyroid cancer. Observed specialty-related variation should be interpreted cautiously, and prospective studies incorporating tumor-level variables and provider/center characteristics are needed. Emphasis should remain on timely surgery within multidisciplinary care pathways.