Bilimoria Karl Y, Bentrem David J, Linn John G, Freel Andrew, Yeh Jen Jen, Stewart Andrew K, Winchester David P, Ko Clifford Y, Talamonti Mark S, Sturgeon Cord
Department of Surgery, Division of Surgical Oncology, Northwestern University, Chicago, Ill., USA.
Surgery. 2007 Dec;142(6):906-13; discussion 913.e1-2. doi: 10.1016/j.surg.2007.09.002. Epub 2007 Nov 5.
Despite guidelines that recommend total thyroidectomy for papillary thyroid cancer (PTC) greater than or equal to 1 cm, the extent of surgery remains controversial. We examined surgical practice patterns for PTC greater than or equal to 1 cm and identified factors that predict the use of total thyroidectomy.
Of 90,382 patients in the National Cancer Center Data Base (NCDB) with PTC from 1985 to 2003, 57,243 patients had tumors greater than or equal to 1 cm and underwent total thyroidectomy or lobectomy. Trends in extent of surgery for PTC were examined over 2 decades. Logistic regression was used to identify factors that predict use of total thyroidectomy compared with lobectomy.
Use of total thyroidectomy increased from 70.8% in 1985 to 90.4% in 2003 (P < .0001). Patients were less likely to undergo total thyroidectomy if they were black, older than 45 years, had Medicare, had lower household incomes, or had less education (P < .0001). Moreover, patients treated at high-volume or academic centers were more likely to undergo total thyroidectomy than were patients examined at low-volume or community hospitals (P < .0001).
Use of total thyroidectomy for PTC greater than or equal to 1 cm increased over time. Differences in use of total thyroidectomy are related to patient, tumor, and hospital factors and likely reflect disparities in access to care.
尽管指南推荐对直径大于或等于1厘米的乳头状甲状腺癌（PTC）行全甲状腺切除术，但手术范围仍存在争议。我们研究了直径大于或等于1厘米的PTC的手术实践模式，并确定了预测全甲状腺切除术使用情况的因素。
在1985年至2003年国家癌症中心数据库（NCDB）中90382例PTC患者中，57243例患者肿瘤直径大于或等于1厘米，并接受了全甲状腺切除术或甲状腺叶切除术。对20多年来PTC手术范围的趋势进行了研究。采用逻辑回归分析确定与甲状腺叶切除术相比，预测全甲状腺切除术使用情况的因素。
全甲状腺切除术的使用率从1985年的70.8%上升至2003年的90.4%（P <.0001）。黑人、年龄大于45岁、拥有医疗保险、家庭收入较低或受教育程度较低的患者接受全甲状腺切除术的可能性较小（P <.0001）。此外，在高容量或学术中心接受治疗的患者比在低容量或社区医院接受检查的患者更有可能接受全甲状腺切除术（P <.0001）。
随着时间的推移，直径大于或等于1厘米的PTC患者全甲状腺切除术的使用率有所增加。全甲状腺切除术使用情况的差异与患者、肿瘤和医院因素有关，可能反映了医疗服务可及性的差异。
