title: Impact of extent of surgery on survival for papillary thyroid cancer patients younger than 45 years.
abstract: BACKGROUND
  Papillary thyroid cancer (PTC) patients <45 years old are considered to have an excellent prognosis; however, current guidelines recommend total thyroidectomy for PTC tumors >1.0 cm, regardless of age.
  
  
  OBJECTIVE
  Our objective was to examine the impact of extent of surgery on overall survival (OS) in patients <45 years old with stage I PTC of 1.1 to 4.0 cm.
  
  
  METHODS
  Adult patients <45 years of age undergoing surgery for stage I PTC were identified from the National Cancer Data Base (NCDB, 1998-2006) and the Surveillance, Epidemiology, and End RESULTS dataset (SEER, 1988-2006).
  
  
  METHODS
  Multivariable modeling was used to compare OS for patients undergoing total thyroidectomy vs lobectomy.
  
  
  RESULTS
  In total, 29 522 patients in NCDB (3151 lobectomy, 26 371 total thyroidectomy) and 13 510 in SEER (1379 lobectomy, 12 131 total thyroidectomy) were included. Compared with patients undergoing lobectomy, patients having total thyroidectomy more often had extrathyroidal and lymph node disease. At 14 years, unadjusted OS was equivalent between total thyroidectomy and lobectomy in both databases. After adjustment, OS was similar for total thyroidectomy compared with lobectomy across all patients with tumors of 1.1 to 4.0 cm (NCDB: hazard ratio = 1.45 [confidence interval = 0.88-2.51], P = 0.19; SEER: 0.95 (0.70-1.29), P = 0.75) and when stratified by tumor size: 1.1 to 2.0 cm (NCDB: 1.12 [0.50-2.51], P = 0.78; SEER: 0.95 [0.56-1.62], P = 0.86) and 2.1 to 4.0 cm (NCDB: 1.93 [0.88-4.23], P = 0.10; SEER: 0.94 [0.60-1.49], P = 0.80).
  
  
  CONCLUSIONS
  After adjusting for patient and clinical characteristics, total thyroidectomy compared with thyroid lobectomy was not associated with improved survival for patients <45 years of age with stage I PTC of 1.1 to 4.0 cm. Additional clinical and pathologic factors should be considered when choosing extent of resection.
authors.affiliation: Department of Surgery (M.A.A., R.P.S., S.A.R., J.A.S.), Duke University Medical Center; Department of Biostatistics (J.P., T.H.), Duke University; and Duke Clinical Research Institute (P.G., M.A.D., S.D.R., J.A.S.), Durham, North Carolina 27710.
authors.forename: Mohamed Abdelgadir
authors.initials: MA
authors.lastname: Adam
authors.forename: John
authors.initials: J
authors.lastname: Pura
authors.forename: Paolo
authors.initials: P
authors.lastname: Goffredo
authors.forename: Michaela A
authors.initials: MA
authors.lastname: Dinan
authors.forename: Terry
authors.initials: T
authors.lastname: Hyslop
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
authors.forename: Randall P
authors.initials: RP
authors.lastname: Scheri
authors.forename: Sanziana A
authors.initials: SA
authors.lastname: Roman
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
mesh_terms: D000328:Adult; D002291:Carcinoma, Papillary / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D018426:SEER Program; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000401:mortality* / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*