Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Endocrine and Oncological Surgery Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Head Neck. 2020 Sep;42(9):2257-2266. doi: 10.1002/hed.26159. Epub 2020 Apr 10.
Thyroid tumor size is an important prognostic factor. The aim of this study is to examine the histological subtypes and management of thyroid cancer based on tumor size (≤4 cm vs >4 cm).
Retrospective cohort study utilizing the National Cancer Database, 2004-2014.
A total of 152 387 patients were included, 13 614 (8.9%) of whom had a tumor size >4 cm. Histological subtypes of tumors >4 cm were: 69.6% papillary thyroid carcinoma, 17.5% FTC, 7.9% HCC, and 2.8% medullary thyroid carcinoma (MTC). High-volume hospitals for thyroid surgery were less likely to perform two-stage thyroidectomy, particularly for tumors ≤4 cm. Low-volume hospitals had a higher risk of staged thyroidectomy for MTC ≤4 cm (19.8%) compared with high-volume hospitals (8.7%) (P < .001).
This study describes the prevalence of thyroid cancer subtypes. In the era of a conservative approach to differentiated thyroid carcinoma, there could be a potential increase in the risk of staged thyroidectomy.
甲状腺肿瘤大小是一个重要的预后因素。本研究旨在根据肿瘤大小（≤4cm 与＞4cm）检查甲状腺癌的组织学亚型和治疗方法。
利用国家癌症数据库进行回顾性队列研究，时间范围为 2004 年至 2014 年。
共纳入 152387 例患者，其中 13614 例（8.9%）肿瘤大小＞4cm。＞4cm 肿瘤的组织学亚型为：69.6%甲状腺乳头状癌、17.5%滤泡状甲状腺癌、7.9%髓样癌和 2.8%甲状腺髓样癌。甲状腺手术量大的医院进行两阶段甲状腺切除术的可能性较小，尤其是针对≤4cm 的肿瘤。低容量医院进行分期甲状腺切除术的风险较高，对于≤4cm 的 MTC 而言（19.8%）比高容量医院（8.7%）更高（P＜0.001）。
本研究描述了甲状腺癌亚型的流行情况。在分化型甲状腺癌保守治疗的时代，分期甲状腺切除术的风险可能会增加。
