Extent of Surgery Not Associated with Overall Survival in Patients with Intermediate-Sized Follicular Thyroid Cancer

by Linda Kossoff •

What is the association between the extent of surgery and overall survival in patients with intermediate-sized follicular thyroid cancer (FTC)?

BOTTOM LINE

Extent of surgery for patients with FTC 1–4 cm was not associated with a significant difference in survival.

BACKGROUND: The prognosis for patients with FTC is favorable, with 20-year survival rates close to 70% when appropriately treated. American Thyroid Association guidelines recommend lobectomy for cancer <1 cm in size and near total or total thyroidectomy for cancer >4 cm. However, tumor T stage offers a more complete clinical picture than size.

STUDY DESIGN: Retrospective database analysis.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, N.J.

SYNOPSIS: Researchers queried the National Cancer Database and identified 6,871 adult patients (5,286 females) who underwent surgical intervention for FTC size 1–4 cm from 2004 to 2016. Patients were divided into two cohorts based on extent of surgery: lobectomy (>1 lobe resected, 1,507 patients) and thyroidectomy (total or near total resection, 5,364 patients). Survival analyses were performed for the overall sample and for tumor T stages I, II, and III–IV. Adjustments were made for patient, clinical, and tumor factors. Pearson’s chi-squared analysis was used to compare cohorts. Patients undergoing lobectomy have a mean survival of 12.94, versus 12.71 years for those undergoing thyroidectomy. Extent of surgery was not associated with a significant difference in survival. Stratification by tumor grade resulted in no significant difference in survival rates. The study showed that total or near-total thyroidectomy is more frequently performed for FTC between 1–4 cm (78.1% of cases) than lobectomy. Authors noted differences concerning multifocality incidence, however, suggesting more complex disease in the thyroidectomy group. Study limitations included limited data on quality-of-life measures and long-term patient outcomes beyond survival.

CITATION: Kethidi N, Vedula S, Shihora D, et al. Extent of surgery for follicular thyroid carcinoma. Laryngoscope. 2023;133:993-999.