Department of Thyroid and Parathyroid Surgery, Laboratory of thyroid and parathyroid disease, Frontiers Science Center for Disease-related Molecular Network, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
World J Surg. 2022 Jan;46(1):104-111. doi: 10.1007/s00268-021-06337-4. Epub 2021 Oct 11.
To analyze the effect of total thyroidectomy (TT) and thyroid lobectomy (LT) on the long-term prognosis of follicular thyroid carcinoma (FTC) without extrathyroidal extension and distant metastasis and to clarify whether the tumor size (≤ 40 mm vs. > 40 mm) has an important impact on the extent of surgery.
Data on FTC patients without extrathyroidal extension and distant metastasis treated with either TT or LT between 1998 and 2016 were extracted from the Surveillance, Epidemiology, and End Results Database. Propensity score matching was performed to minimize impact of selection bias and potential confounding. Kaplan-Meier curves and Cox regression analysis were conducted to assess the impact of the extent of surgery on disease-specific survival (DSS).
A total of 8435 patients were identified. The DSS after LT were 100%, 98.3%, and 97.6% at 5, 10, and 15 years, respectively, compared with those seen after TT of 99.3%, 97.9%, and 96.6%. The difference between the two groups is not statistically significant (p = 0.083). Similar results were observed in cohorts after adjusting for baseline covariates. There was also similar prognosis between LT and TT in patients with tumors size ≤ 40 mm or > 40 mm.
For patients with FTC of any size without extrathyroidal extension and distant metastases at diagnosis, TT and LT confer equivalent DSS. Completion thyroidectomy after LT may be not necessary unless patients relapse; however, recurrence rates and development of metastases are not evaluated in this study.
分析甲状腺全切除术（TT）和甲状腺叶切除术（LT）对无甲状腺外侵犯和远处转移的滤泡状甲状腺癌（FTC）的长期预后的影响，并阐明肿瘤大小（≤40mm 与>40mm）是否对手术范围有重要影响。
从 1998 年至 2016 年的监测、流行病学和最终结果数据库中提取了无甲状腺外侵犯和远处转移的 FTC 患者接受 TT 或 LT 治疗的数据。采用倾向评分匹配法尽量减少选择偏差和潜在混杂因素的影响。采用 Kaplan-Meier 曲线和 Cox 回归分析评估手术范围对疾病特异性生存（DSS）的影响。
共确定了 8435 例患者。LT 后的 DSS 分别为 5 年、10 年和 15 年时的 100%、98.3%和 97.6%，而 TT 后的 DSS 分别为 99.3%、97.9%和 96.6%。两组间差异无统计学意义（p=0.083）。在调整基线协变量后，两组的结果相似。在肿瘤大小≤40mm 或>40mm 的患者中，LT 和 TT 的预后也相似。
对于无甲状腺外侵犯和远处转移的任何大小 FTC 患者，TT 和 LT 可获得相当的 DSS。除非患者复发，否则 LT 后行甲状腺全切除术可能没有必要；然而，本研究未评估复发率和转移的发展。
