Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Surgery. 2021 Jan;169(1):14-21. doi: 10.1016/j.surg.2020.03.022. Epub 2020 May 28.
Prior studies demonstrated that older adults tend to undergo less surgery for thyroid cancer. Our objective was to use a discrete choice experiment to identify factors influencing surgical decision-making for older adults with thyroid cancer.
Active and candidate members of the American Association of Endocrine Surgeons were invited to participate in a web-based survey. Multinomial logistic regression was utilized to assess patient and surgeon factors associated with treatment choices.
Complete survey response rate was 25.7%. Most respondents were high-volume surgeons (88.5%) at academic centers (76.9%). Multinomial logistic regression demonstrated that patient age was the strongest predictor of management. Increasing age and comorbidities were associated with the choice for active surveillance (P = .000), not performing a lymphadenectomy in patients with nodal metastases (relative-risk ratio: 2.5, 95% CI: 1.4-4.2, P = .002 and relative-risk ratio: 1.6, 95% CI: 1.2-2.1, P = .004, respectively), and recommending hemithyroidectomy versus total thyroidectomy for a cancer >4 cm (relative-risk ratio: 4.4, 95% CI: 2.5-7.9, P = .000 and relative-risk ratio: 3.4, 95% CI: 2.3-5.1, P = .000, respectively). Surgeons with ≥10 years of experience (relative-risk ratio: 3.3, 95% CI: 1.1-10.3, P = .039) favored total thyroidectomy for a cancer <4 cm, and nonfellowship trained surgeons (relative-risk ratio: 7.3, 95% CI: 1.3-42.2, P = .027) opted for thyroidectomy without lymphadenectomy for lateral neck nodal metastases.
This study highlights the variation in surgical management of older adults with thyroid cancer and demonstrates the influence of patient age, comorbidities, surgeon experience, and fellowship training on management of this population.
先前的研究表明，老年人接受甲状腺癌手术的比例较低。我们的目的是使用离散选择实验来确定影响老年甲状腺癌患者手术决策的因素。
邀请美国内分泌外科学会的活跃成员和候选成员参与基于网络的调查。采用多项逻辑回归分析评估与治疗选择相关的患者和外科医生因素。
完整调查的回复率为 25.7%。大多数受访者是在学术中心工作的高容量外科医生（88.5%）。多项逻辑回归表明，患者年龄是管理的最强预测因素。年龄增长和合并症与主动监测的选择有关（P=0.000），与淋巴结转移患者不进行淋巴结切除术有关（相对风险比：2.5，95%CI：1.4-4.2，P=0.002 和相对风险比：1.6，95%CI：1.2-2.1，P=0.004），以及建议对于>4cm 的癌症进行半甲状腺切除术与全甲状腺切除术（相对风险比：4.4，95%CI：2.5-7.9，P=0.000 和相对风险比：3.4，95%CI：2.3-5.1，P=0.000）。具有≥10 年经验的外科医生（相对风险比：3.3，95%CI：1.1-10.3，P=0.039）倾向于对<4cm 的癌症进行全甲状腺切除术，而非接受过专科培训的外科医生（相对风险比：7.3，95%CI：1.3-42.2，P=0.027）选择对侧颈部淋巴结转移进行无淋巴结切除术的甲状腺切除术。
本研究强调了老年甲状腺癌患者手术管理的变化，并表明患者年龄、合并症、外科医生经验和专科培训对该人群管理的影响。
