The impact of surgery refusal on thyroid cancer survival: a SEER-based analysis
- PDF / 579,392 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 80 Downloads / 165 Views
ORIGINAL ARTICLE
The impact of surgery refusal on thyroid cancer survival: a SEER-based analysis Maaike van Gerwen1,2 Catherine Sinclair3 Maleeha Rahman2 Eric Genden1 Emanuela Taioli2,4,5 ●
●
●
●
1234567890();,:
1234567890();,:
Received: 18 December 2019 / Accepted: 1 April 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose In the current era of de-escalation of surgical treatment for low-risk thyroid cancer, it is important to ensure that the natural history of thyroid cancer is as benign as has been suggested previously. We therefore compared the impact of surgery refusal and surgery on disease-specific survival (DSS) in patients with local or regional, papillary thyroid cancer (PTC). Methods Local and regional stage PTC patients in the Surveillance, Epidemiology, and End Results Program (1988–2015) were included. Cox proportional hazard modeling and propensity score matching were conducted to evaluate DSS. Results There were 45,136 patients who received surgery and 146 patients who had surgery recommended but refused. Adjusted analysis showed a significantly better DSS for the surgery group compared with the refusal group (HRadj: 3.07 (95% CI: 1.54–6.11). After stratification for stage, no statistically significant difference in DSS was found (HRadj: 3.03 (0.89–10.35) when including only local stage PTC. Propensity matching showed a 10-year DSS of 94.0% (95% CI: 87.7–97.1%) and 96.4% (95% CI: 93.2–98.1%) for the refusal and surgery group (p = 0.060). Propensity matching of local stage PTC showed a 10-year DSS of 96.7% (95% CI: 89.9–98.9%) and 100%, respectively (p = 0.002). Conclusion Although no significant difference in survival was found between surgery and no surgery in local stage PTC, a 3.3% improvement of 10-year DSS was found in the surgery group. Overall, these results suggest that local stage PTC has a benign natural history, and that conservative management strategies such as active surveillance may be appropriate. Keywords Thyroid cancer Surgery Oncological outcomes Natural course ●
●
●
Introduction
Supplementary information The online version of this article (https:// doi.org/10.1007/s12020-020-02301-9) contains supplementary material, which is available to authorized users. * Emanuela Taioli [email protected] 1
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
2
Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
3
Department of Head and Neck Surgery, Mount Sinai West Hospital, New York, NY, USA
4
Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
5
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Thyroid cancer incidence has been steadily increasing since the 1970s mainly because of an increase in small, papillary thyroid cancers, while the incidence of follicular, medullary, and anaplastic thyroid cancer has not significantly ch
Data Loading...
