Montgomery Kelsey B, Fazendin Jessica M, Chen Herbert, Broman Kristy K
Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Am J Surg. 2024 Feb;228:173-179. doi: 10.1016/j.amjsurg.2023.09.021. Epub 2023 Sep 15.
Although lobectomy is acceptable for patients with small, low-risk differentiated thyroid cancer (DTC), gross extrathyroidal extension (ETE) remains an indication for total thyroidectomy (TT). Here we investigate evolving trends in extent of surgery for + ETE DTC.
Patients with +ETE DTC who underwent resection from 2010 to 2020 were identified using the National Cancer Database. The primary outcome was performance of TT versus lobectomy.
Among 5851 patients, most were female (79.7%), white (80.0%), and had minimal ETE (91.8%). Ninety-two percent of patients received TT. Year of treatment was influential (p < 0.001), with increasing lobectomy rates in later years. On multivariable analyses, a decreased likelihood of TT was seen in years 2015 through 2020.
Most patients with +ETE DTC underwent guideline-concordant TT, but lobectomy rates doubled over the study period. These findings may reflect increased preference for lobectomy in low-risk DTC, but could undertreat patients with high-risk features.
虽然对于小型、低风险分化型甲状腺癌（DTC）患者，肺叶切除术是可以接受的，但肉眼可见的甲状腺外侵犯（ETE）仍然是全甲状腺切除术（TT）的指征。在此，我们研究了伴有ETE的DTC手术范围的演变趋势。
利用国家癌症数据库识别出2010年至2020年期间接受切除术的伴有ETE的DTC患者。主要结局是TT与肺叶切除术的实施情况。
在5851例患者中，大多数为女性（79.7%）、白人（80.0%），且ETE程度较轻（91.8%）。92%的患者接受了TT。治疗年份有影响（p<0.001），后期肺叶切除术率增加。在多变量分析中，2015年至2020年期间TT的可能性降低。
大多数伴有ETE的DTC患者接受了符合指南的TT，但在研究期间肺叶切除术率翻了一番。这些发现可能反映出在低风险DTC中对肺叶切除术的偏好增加，但可能会对具有高风险特征的患者治疗不足。
