Halagur Akash S, Huynh Jeffrey D, Megwalu Uchechukwu C
Department of Otolaryngology-Head and Neck Surgery Stanford University School of Medicine Stanford California USA.
Geisel School of Medicine at Dartmouth Hanover New Hampshire USA.
Laryngoscope Investig Otolaryngol. 2025 Jun 24;10(3):e70175. doi: 10.1002/lio2.70175. eCollection 2025 Jun.
The 2015 American Thyroid Association (ATA) guidelines recommended lobectomy for management of low-risk differentiated thyroid carcinomas (DTC), aiming to mitigate overtreatment. The primary objective of this study was to assess the impact of the 2015 ATA guidelines on the rates of lobectomy versus total thyroidectomy for the treatment of low-risk DTC, using the Surveillance, Epidemiology, and End Results (SEER) 17 database. Our secondary objectives were to examine the modifying effects of tumor size on the change in the rates of lobectomy between the pre- and post-guideline periods and to identify factors that are associated with the use of lobectomy in the post-guideline period.
A retrospective cohort analysis of adults diagnosed with low-risk DTC from 2011 to 2020 was conducted using the SEER 17 database. Logistic regression assessed the likelihood of lobectomy and total thyroidectomy before and after guideline implementation, including size-stratified and post-guideline subgroup analyses.
Among 61,078 patients, lobectomy rates increased from 16% pre-guideline to 25% post-guideline (aOR 1.81, 95% CI 1.74-1.89). Lobectomy increased across both T1 and T2 tumors; post-guideline subgroup analysis indicates T2 tumors were less likely to receive lobectomy than T1 tumors.
The use of lobectomy for treatment of low-risk DTC has significantly increased since the publication of the 2015 ATA guidelines. However, total thyroidectomy remains the predominant treatment.
Level 3.
2015年美国甲状腺协会（ATA）指南推荐对低风险分化型甲状腺癌（DTC）采用肺叶切除术进行治疗，旨在减少过度治疗。本研究的主要目的是利用监测、流行病学和最终结果（SEER）17数据库，评估2015年ATA指南对低风险DTC治疗中肺叶切除术与全甲状腺切除术比例的影响。我们的次要目的是研究肿瘤大小对指南发布前后肺叶切除术比例变化的修正作用，并确定与指南发布后肺叶切除术使用相关的因素。
使用SEER 17数据库对2011年至2020年诊断为低风险DTC的成年人进行回顾性队列分析。逻辑回归评估指南实施前后肺叶切除术和全甲状腺切除术的可能性，包括按大小分层和指南发布后的亚组分析。
在61078例患者中，肺叶切除术比例从指南发布前的16%增加到指南发布后的25%（调整后比值比1.81，95%可信区间1.74-1.89）。T1和T2肿瘤的肺叶切除术比例均有所增加；指南发布后的亚组分析表明，T2肿瘤接受肺叶切除术的可能性低于T1肿瘤。
自2015年ATA指南发布以来，低风险DTC治疗中肺叶切除术的使用显著增加。然而，全甲状腺切除术仍然是主要的治疗方法。
3级。
