Divisions of Metabolism, Endocrinology, and Diabetes and Hematology/Oncology, University of Michigan, Ann Arbor, MI 48109, USA.
Ann Surg. 2013 Aug;258(2):354-8. doi: 10.1097/SLA.0b013e31826c8915.
By linking surgeon surveys to the National Cancer Database, we found that surgeons' tendency to perform more extensive thyroid resection is associated with greater use of radioactive iodine for stage I thyroid cancer.
To determine the relationships between surgeon recommendations for extent of resection and radioactive iodine use in low-risk thyroid cancer.
There has been an increase in thyroid cancer treatment intensity; the relationship between extent of resection and medical treatment with radioactive iodine remains unknown.
We randomly surveyed thyroid surgeons affiliated with 368 hospitals with Commission on Cancer-accredited cancer programs. Survey responses were linked to the National Cancer Database. The relationship between extent of resection and the proportion of the American Joint Committee on Cancer stage I well-differentiated thyroid cancer patients treated with radioactive iodine after total thyroidectomy was assessed with multivariable weighted regression, controlling for hospital and surgeon characteristics.
The survey response rate was 70% (560/804). Surgeons who recommend total thyroidectomy over lobectomy for subcentimeter unifocal thyroid cancer were significantly more likely to recommend prophylactic central lymph node dissection for thyroid cancer regardless of tumor size (P < 0.001). They were also more likely to favor radioactive iodine in patients with intrathyroidal unifocal cancer ≤1 cm (P = 0.001), 1.1-2 cm (P = 0.004), as well as intrathyroidal multifocal cancer ≤1 cm (P = 0.004). In multivariable analysis, high hospital case volume, fewer surgeon years of experience, general surgery specialty, and preference for more extensive resection were independently associated with greater hospital-level use of radioactive iodine for stage I disease.
In addition to surgeon experience and specialty, surgeons' tendency to perform more extensive thyroid resection is associated with greater use of radioactive iodine for stage I thyroid cancer.
通过将外科医生调查与国家癌症数据库联系起来，我们发现外科医生进行更广泛甲状腺切除术的倾向与对 I 期甲状腺癌使用放射性碘的倾向相关。
确定外科医生对切除范围的建议与低危甲状腺癌中放射性碘使用之间的关系。
甲状腺癌治疗强度有所增加；切除范围与放射性碘治疗之间的关系尚不清楚。
我们随机调查了隶属于 368 家具有癌症委员会认证癌症计划的医院的甲状腺外科医生。调查结果与国家癌症数据库相关联。使用多变量加权回归评估甲状腺全切除术后 AJCC 分期 I 期分化良好的甲状腺癌患者中，切除范围与接受放射性碘治疗的比例之间的关系，控制医院和外科医生的特征。
调查的回复率为 70%（560/804）。对于亚厘米单发甲状腺癌，建议行甲状腺全切除术而不是甲状腺叶切除术的外科医生，无论肿瘤大小如何，都更有可能推荐预防性中央淋巴结清扫术治疗甲状腺癌（P<0.001）。他们也更倾向于在甲状腺内单发肿瘤≤1cm（P=0.001）、1.1-2cm（P=0.004）以及甲状腺内多发肿瘤≤1cm（P=0.004）的患者中使用放射性碘。在多变量分析中，高医院病例量、外科医生经验年限少、普通外科专业以及更广泛切除的偏好与 I 期疾病放射性碘的使用量更大相关。
除了外科医生的经验和专业知识外，外科医生进行更广泛甲状腺切除术的倾向与 I 期甲状腺癌中放射性碘的使用量增加相关。
