Total Thyroidectomy vs Thyroid Lobectomy for Localized Papillary Thyroid Cancer in Children: A Propensity-Matched Survival Analysis
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Read the article on pubmed.ncbi.nlm.nih.gov ↗Article · Jun 2021 · 1 min read
In brief
In brief
Propensity-matched analysis of 326 pediatric patients with localized papillary thyroid cancer found no survival difference between total thyroidectomy and thyroid lobectomy for tumors under 4cm. Study challenges current aggressive treatment guidelines, suggesting lobectomy may be adequate for early-stage disease while avoiding lifelong hormone replacement.
Written by the GCMD Library team from the article.
Introduction: Current guidelines recommend total thyroidectomy (TT) and radio-ablation for most papillary thyroid cancer (PTC) in children. These guidelines have been criticized as aggressive, especially for early-stage PTC, as it likely does not influence patient survival and results in life-long thyroid hormone replacement. We sought to study whether the extent of thyroidectomy (TT vs. thyroid lobectomy (TL)) influences the overall and disease-specific survival in children with localized PTC.
Methods: The National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) registries were queried. Patients ≤18 years old with low-risk PTC between 2004 and 2016 were included. Using a 1:1 propensity score matching, patients who underwent TT were matched for age, sex, race, year of diagnosis, and tumor size- with a similar cohort of patients who underwent TL. Primary endpoints were overall survival (OS) and disease-specific survival (DSS).
Results: 3,500 patients were identified as surgically treated for PTC, out of which 1,325 patients met inclusion criteria for matching. Three hundred twenty-six patients were matched. One hundred sixty-three patients (140 females) with a mean age of 16(13- 17) had TT. One hundred sixty-three patients (140 females) with a mean age of 16(14- 17) had TL. Median follow-up was 5.0 (IQR 2.8, 8) and 8.3 (IQR 3.6 -14.4) years in the NCBD and SEER cohorts, respectively. There was no statistically significant difference in OS or DSS in patients with PTC < 4cm regardless of whether patients underwent a TT or TL [ P =0.32 (NCDB) and P = 0.67 (SEER)].
Conclusion: This study suggests that the extent of thyroidectomy does not influence survival for pediatric patients with early-stage PTC and that TL may be adequate in this patient population.
DOI: 10.1016/j.jamcollsurg.2021.03.025