Papillary Thyroid Microcarcinoma: An Over-Treated Malignancy?

• Published in: World journal of surgery 2014-09, Vol.38 (9), p.2297-2303
• Main Authors: Wang, Tracy S., Goffredo, Paolo, Sosa, Julie Ann, Roman, Sanziana A.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adolescent; Adult; Age Factors; Aged; Carcinoma, Papillary - radiotherapy; Carcinoma, Papillary - surgery; Cardiac Surgery; Differentiate Thyroid Cancer; Disease-Free Survival; Female; General Surgery; Humans; Iodine Radioisotopes - therapeutic use; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; National Comprehensive Cancer Network; Neoplasms, Multiple Primary - radiotherapy; Neoplasms, Multiple Primary - surgery; Overall Survival; Papillary Thyroid Cancer; Practice Guidelines as Topic; Radiotherapy, Adjuvant - utilization; SEER Program; Sex Factors; Surgery; Survival Rate; Thoracic Surgery; Thyroid Neoplasms - radiotherapy; Thyroid Neoplasms - surgery; Thyroidectomy - methods; Thyroidectomy - utilization; Total Thyroidectomy; United States; Vascular Surgery; Young Adult
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-014-2602-3

Background The clinical importance of papillary thyroid microcarcinoma (PTMC) remains controversial, with current guidelines suggesting that thyroid lobectomy alone is sufficient. The purpose of this study was to identify population-level treatment patterns in the USA for PTMC. Methods Patients with PTMC in SEER (1998–2010) were included; demographic, clinical (extent of surgery, administration of post-operative radioactive iodine [RAI]), and pathologic characteristics were examined. Outcomes of interest were 5- and 10-year overall survival (OS) and disease-specific survival (DSS). Results The cohort consisted of 29,512 patients. Mean age at diagnosis was 48.5 years; mean tumor size was 0.53 cm. Overall, 73.4 % of patients underwent total thyroidectomy, and RAI was administered to 31.3 %. In multivariate analysis, total thyroidectomy was more frequently performed in patients with multifocal (odds ratio [OR] 2.55), ‘regional’, or ‘distant’ PTMC (OR 2.90 and 2.59). Non-operative management was associated with male patients (OR 4.24) and those aged ≥65 years (OR 6.31). Post-operative RAI was associated with multifocal PTMC (OR 2.57). Overall, 5- and 10-year DSS was 99.6 and 99.3 %, respectively, with no difference in DSS between patients who underwent partial versus total thyroidectomy. OS of patients with PTMC who underwent any thyroid operation was similar to that of the general population of the USA. Conclusions An increasing number of patients are undergoing total thyroidectomy and RAI for PTMC. While there may be a subset of patients for whom more aggressive therapy is indicated, many patients with PTMC may be over-treated, with no demonstrable benefit to survival.