title: Paradoxes in thyroid carcinoma treatment: analysis of the SEER database 2010-2013.
abstract: Thyroid cancer is a common malignant disease with high survival rate (98.1%, 2006-2012, Surveillance Epidemiology and End Results (SEER) program). In this study, we investigated the treatment paradoxes in thyroid T0 and micro-carcinoma patients. 48,234 thyroid carcinoma patients were identified from 2010 to 2013 in SEER*Stat database (version 8.2.1) released in 2016. Survival analysis showed a significantly lower thyroid carcinoma-specific survival in T0 patients compared with T1-T3 patients. In propensity score analysis, T0 patients had a similar survival curve with T1-T3 patients when lymph node and distant metastasis stages were matched. When all variables, including radiation and surgery treatment, were matched, T0 patients had significantly higher survival compared to T3 patients. These findings suggested that more metastasis and less treatment led to poorer prognosis in T0 patients. Another paradox is about thyroid micro-carcinoma. The survival rate of micro-carcinoma patients was high (4 years survival rate was 99.92%), and more than 99% micro-carcinoma patients received surgery. Interestingly, all the patients who died because of thyroid carcinoma received surgery. Survival analysis showed no difference in survival when patients stratified by surgery or radiation. In conclusion, we suggested paradoxes in thyroid carcinoma treatment: over-treated in micro-carcinoma patients and less-treated in T0 patients.
authors.affiliation: Department of Ultrasound, the Third Xiangya Hospital of Central South University, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Zhou
authors.affiliation: Department of Ultrasound, the Third Xiangya Hospital of Central South University, China.
authors.forename: Shuangming
authors.initials: S
authors.lastname: Tian
authors.affiliation: Department of Ultrasound, the Third Xiangya Hospital of Central South University, China.
authors.forename: Jiale
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Ultrasound, the Third Xiangya Hospital of Central South University, China.
authors.forename: Yongfeng
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Ultrasound, the Third Xiangya Hospital of Central South University, China.
authors.forename: Wengang
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Ultrasound, the Third Xiangya Hospital of Central South University, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Ultrasound, the Third Xiangya Hospital of Central South University, China.|Information Security and Big Data Institution, Central South University, China.
authors.forename: Zheyu
authors.initials: Z
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D057216:Propensity Score; D018426:SEER Program / Q000706:statistics & numerical data*; D016019:Survival Analysis; D015996:Survival Rate; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*
keywords: cox regression model; epidemiology and end results (SEER) database; propensity score; surgery and radiation treatment; thyroid carcinoma