Faculty Collaboration Database

A single institution experience with papillary thyroid cancer: Are outcomes better at comprehensive cancer centers? Am J Surg 2021 Oct;222(4):802-805

Date

03/08/2021

Pubmed ID

33676725

Pubmed Central ID

PMC8408279

DOI

10.1016/j.amjsurg.2021.02.027

Scopus ID

2-s2.0-85102028918 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

INTRODUCTION: Papillary thyroid cancer (PTC) is the most common form of thyroid cancer. Although the survival rate is excellent, recurrence is as high as 20%. The mainstay of therapy is thyroidectomy and lymph node dissection based on risk factors. Data from other cancers suggest that surgical outcomes are most optimal at comprehensive cancer centers. We hypothesize that patients with PTC who had their initial operation at a comprehensive cancer center would have a better oncologic outcome.

METHODS: We utilized an IRB-approved cancer care registry database of patients with thyroid cancer who were seen at our institution between 2000 and 2018. Patient records were updated with cancer-specific outcomes including recurrence and need for re-intervention. Clinical and surgical outcomes were then compared between patients who had their initial operation at a comprehensive cancer center (CCC group, n = 503) versus those who did not (non-CCC group, n = 72).

RESULTS: Mean patient age was 49 ± 16 years and 70% were female. Average tumor size was 1.6 ± 1.6 cm. There was no difference in tumor size, age, gender or race between groups. Pre-operative ultrasound was more frequently performed at the CCC (89%) than at non-CCC's (51%, p < 0.001). CCC patients were more likely to undergo initial total thyroidectomies compared to non-CCC patients (76% vs. 21%, p < 0.001). Positive surgical margins were more frequently found in patients at non-CCC's (19%) than at the CCC (9.7%, p = 0.016). Finally, CCC patients had a significantly lower cancer recurrence rate (5.0% vs. 37.5%, p < 0.001). Therefore, the need for additional cancer operations was much greater in patients who had initial thyroid surgery at non-CCC (31.9% vs. 1.4%, p < 0.001).

CONCLUSIONS: Patients with PTC who have their initial thyroidectomy at non-CCC have higher recurrence rates, higher rates of positive tumor margins on pathology, and increased need for additional operations. These data suggest that patients who have their initial procedure at a CCC for PTC have better long-term outcomes.

Author List

Aryanpour Z, Asban A, Boyd C, Herring B, Eustace N, Carmona Matos DM, McCaw T, Ramonell KM, Fazendin JM, Lindeman B, Iyer P, Chen H

Author

Pallavi Iyer MD Chief, Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cancer Care Facilities
Female
Humans
Lymph Node Excision
Male
Margins of Excision
Middle Aged
Neoplasm Recurrence, Local
Reoperation
Thyroidectomy
Ultrasonography