美国低危型甲状腺乳头状癌手术范围演变的差异。
Evolving variation in the extent of surgery for low-risk papillary thyroid cancer in the United States.
机构信息
Department of Surgery, University of Alabama at Birmingham, AL.
Department of Surgery, University of Alabama at Birmingham, AL.
出版信息
Surgery. 2023 Oct;174(4):828-835. doi: 10.1016/j.surg.2023.07.001. Epub 2023 Aug 6.
BACKGROUND
The continued debate over total thyroidectomy versus lobectomy and declining favor for prophylactic central neck dissection for patients with clinically node-negative papillary thyroid cancer ≤4 cm is ongoing after the 2015 guideline updates from the American Thyroid Association. This study aimed to evaluate contemporary trends in the extent of surgery in this low-risk cohort.
METHODS
Retrospective data from the National Cancer Database were used to identify adult patients with clinically node-negative papillary thyroid cancer ≤4 cm who underwent resection from 2012 to 2020. The primary outcome was the extent of surgery (lobectomy or total thyroidectomy, with or without prophylactic central neck dissection). Multivariable regression was performed to identify characteristics associated with variation in the extent of surgery.
RESULTS
Of 83,464 included patients, 79.3% were female patients with a median age of 51 years. The majority underwent total thyroidectomy either with prophylactic central neck dissection (39.1%) or without (37.5%) versus lobectomy with prophylactic central neck dissection (7.2%) or without (16.2%). Lobectomy rates increased from 18.3% in 2012 to 29.9% in 2020. Prophylactic central neck dissection rates also increased (42.9% to 52.1%). Patients who were male sex, Asian American, had smaller tumors or were treated at community cancer programs had a decreased likelihood of total thyroidectomy. Patients who were older, male sex, Black race, with smaller tumors, or were treated at community cancer programs or mid- or low-volume facilities had decreased likelihood of prophylactic central neck dissection.
CONCLUSION
Proportional use rates of operative approaches for low-risk, clinically node-negative papillary thyroid cancer have changed in recent years after the American Thyroid Association guideline changes, including increasing overall rates of lobectomy as well as prophylactic central neck dissection, with differences noted based on patient- and facility-level factors.
背景
自 2015 年美国甲状腺协会指南更新以来，对于临床淋巴结阴性的≤4cm 甲状腺乳头状癌患者，甲状腺全切除术与腺叶切除术的持续争论以及对预防性中央颈部清扫术的支持率下降仍在继续。本研究旨在评估这一低危人群中手术范围的当代趋势。
方法
回顾性分析了 2012 年至 2020 年期间，国家癌症数据库中接受手术治疗的临床淋巴结阴性的≤4cm 甲状腺乳头状癌成年患者的资料。主要结局是手术范围（腺叶切除术或甲状腺全切除术，伴或不伴预防性中央颈部清扫术）。采用多变量回归分析确定与手术范围变化相关的特征。
结果
在纳入的 83464 例患者中，79.3%为女性，中位年龄为 51 岁。大多数患者行甲状腺全切除术，伴预防性中央颈部清扫术（39.1%）或不伴预防性中央颈部清扫术（37.5%），行腺叶切除术伴预防性中央颈部清扫术（7.2%）或不伴预防性中央颈部清扫术（16.2%）。腺叶切除术的比例从 2012 年的 18.3%增加到 2020 年的 29.9%。预防性中央颈部清扫术的比例也有所增加（从 42.9%增加到 52.1%）。男性、亚裔、肿瘤较小或在社区癌症项目中接受治疗的患者行甲状腺全切除术的可能性较低。年龄较大、男性、黑人、肿瘤较小或在社区癌症项目或中低容量机构中接受治疗的患者行预防性中央颈部清扫术的可能性较低。
结论
在 2015 年美国甲状腺协会指南更新后，近年来，对于低危、临床淋巴结阴性的甲状腺乳头状癌患者，手术方法的应用比例发生了变化，包括整体腺叶切除术和预防性中央颈部清扫术的比例增加，同时基于患者和机构因素存在差异。
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