Abstract
Abstract
Background:
The approach for surgical treatment of patients with low-/intermediate-risk T1T2N0/Nx well-differentiated thyroid cancer (WDTC)—total thyroidectomy (TT) vs thyroid lobectomy (TL)—remains a controversial topic. Conducting a randomized controlled trial (RCT) would be the gold standard to address this issue. However, this is challenging because of excellent survival outcomes and, therefore, high number of patients and long-term follow-up that would be required. As an alternative to RCT, we have used propensity score (PS) matching to determine whether T1T2N0/Nx patients selected to have TL had equivalent outcomes to a similar group treated with TT.
Methods:
After IRB approval, a database of 6259 patients with WDTC treated with primary surgery at our institution between 1985 and 2016 was analyzed to identify patients with T1T2N0/Nx cancers. Of 3756 patients identified, 943 were managed by TL and 2813 by TT. To control for possible confounders and reduce potential bias, we selected age, gender, histology, iodine 131 therapy, American Thyroid Association (ATA) risk, and American Joint Committee on Cancer (AJCC) stage as our PS matching criteria. Subsequently, 918 TL patients were effectively matched with 918 TT patients. The Pearson χ2 test or Fisher's exact test was used to compare categorical covariates and the Student's t-test was used for comparison of continuous variables between the two groups. Disease-specific survival (DSS), overall survival (OS), and recurrence-free survival (RFS) were calculated using the Kaplan–Meier method and compared using the log-rank test.
Results:
After PS matching, there were no significant differences between TL and TT patients for OS (10-year OS: 92.2% vs 91.3%, p = 0.9668), DSS (10-year DSS: 100% vs 99.1%, p = 0.1967), or RFS (10-year RFS: 99.5% vs 98.3%, p = 0.079).
Conclusions:
For low-/intermediate-risk patients with intrathyroidal cancer <4 cm, patients selected for TL have similar survival outcomes to a comparable group treated by TT.
No competing financial interests exist.
Runtime of video: 9 mins 43 secs
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