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Observation versus thyroidectomy for papillary thyroid microcarcinoma in the elderly

Published online by Cambridge University Press:  23 December 2016

U C Megwalu
U C Megwalu*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, California, USA
*
Address for correspondence: Dr Uchechukwu C Megwalu, Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA Fax: +1 650 725 8502 E-mail: megwaluu@yahoo.com
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Abstract

Objective:

To compare the effectiveness of non-surgical versus surgical therapy in elderly patients with papillary thyroid microcarcinoma.

Methods:

The study cohort included 2323 elderly patients (aged 65 years and over) diagnosed with papillary thyroid microcarcinoma between 1988 and 2009, identified in the Surveillance, Epidemiology, and End Results 18 database of the National Cancer Institute.

Results:

The five-year overall survival rate was 23 per cent for non-surgical patients compared with 91 per cent for surgical patients (p < 0.0001). Unadjusted analysis revealed significantly improved survival in surgical patients compared with non-surgical patients (hazard ratio = 0.06; p < 0.0001). Propensity score analysis also revealed significantly improved survival in surgical patients compared with non-surgical patients (hazard ratio = 0.11; p < 0.0001).

Conclusion:

Thyroidectomy appears to provide a survival benefit for elderly patients with papillary thyroid microcarcinoma. High-quality prospective studies are needed to better evaluate the comparative effectiveness of immediate thyroidectomy versus observation for elderly patients with papillary thyroid microcarcinoma.

Keywords

Thyroid NeoplasmsAgedThyroidectomySEER Program
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 2 , February 2017 , pp. 173 - 176
Copyright
Copyright © JLO (1984) Limited 2016 

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References

1 Kilfoy, BA, Zheng, T, Holford, TR, Han, X, Ward, MH, Sjodin, A et al. International patterns and trends in thyroid cancer incidence, 1973–2002. Cancer Causes Control 2009;20:525–31Google Scholar
2 Davies, L, Welch, HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 2006;295:2164–7Google Scholar
3 Davies, L, Welch, HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg 2014;140:317–22Google Scholar
4 Leenhardt, L, Grosclaude, P, Chérié-Challine, L; Thyroid Cancer Committee. Increased incidence of thyroid carcinoma in France: a true epidemic or thyroid nodule management effects? Report from the French Thyroid Cancer Committee. Thyroid 2004;14:1056–60Google Scholar
5 Hughes, DT, Haymart, MR, Miller, BS, Gauger, PG, Doherty, GM. The most commonly occurring papillary thyroid cancer in the United States is now a microcarcinoma in a patient older than 45 years. Thyroid 2011;21:231–6Google Scholar
6 Davies, L, Ouellette, M, Hunter, M, Welch, HG. The increasing incidence of small thyroid cancers: where are the cases coming from? Laryngoscope 2010;120:2446–51Google Scholar
7 Grodski, S, Brown, T, Sidhu, S, Gill, A, Robinson, B, Learoyd, D et al. Increasing incidence of thyroid cancer is due to increased pathologic detection. Surgery 2008;144:1038–43Google Scholar
8 Harach, HR, Franssila, KO, Wasenius, VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland: a systematic autopsy study. Cancer 1985;56:531–8Google Scholar
9 Sugitani, I, Toda, K, Yamada, K, Yamamoto, N, Ikenaga, M, Fujimoto, Y. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg 2010;34:1222–31Google Scholar
10 Ito, Y, Uruno, R, Nakano, K, Takamura, Y, Miya, A, Kobayashi, K et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 2003;13:381–8Google Scholar
11 Ito, Y, Miyauchi, A, Inoue, H, Fukushima, M, Kihara, M, Higashiyama, T et al. An observation trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg 2010;34:28–35 CrossRefGoogle ScholarPubMed
12 Ito, Y, Miyauchi, A, Kihara, M, Higashiyama, T, Kobayashi, K, Miya, A. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid 2014;24:27–34 Google Scholar
13Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2011 Sub (1973–2009 varying) - Linked To County Attributes - Total U.S., 1969–2010 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2012, based on the November 2011 submissionGoogle Scholar
14 Cooper, GS, Virnig, B, Klabunde, CN, Schussler, N, Freeman, J, Warren, JL. Use of SEER-Medicare data for measuring cancer surgery. Med Care 2002;40:IV-43–48 Google Scholar
15 Rubin, DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med 1997;127:757–63Google Scholar
16 Rubin, DB, Thomas, N. Matching using estimated propensity scores: relating theory to practice. Biometrics 1996;52:249–64Google Scholar
17 Lin, HW, Bhattacharyya, N. Survival impact of treatment options for papillary microcarcinoma of the thyroid. Laryngoscope 2009;119:1983–7Google Scholar
18 Wang, TS, Goffredo, P, Sosa, JA, Roman, SA. Papillary thyroid microcarcinoma: an over-treated malignancy? World J Surg 2014;38:2297–303Google Scholar
19 Berry, SD, Ngo, L, Samelson, EJ, Kiel, DP. Competing risk of death: an important consideration in studies of older adults. J Am Geriatr Soc 2010;58:783–7Google Scholar