RESEARCH OBJECTIVE: The incidence of thyroid cancer has increased considerably over the past few decades, especially papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC). Much of this increase is due to better diagnostics and increased detection of smaller, previously undetectable tumors. Initially, guidelines from the American Thyroid Association (ATA) in 2009 recommended total or near-total thyroidectomy for patients with tumors larger than one centimeter. This was changed in 2015 to recommend hemithyroidectomy (or removal of half of the thyroid) as initial treatment for primary thyroid carcinomas between 1 and 4 centimeters, particularly among PTC and FTC. The objective of this study was to evaluate how initial surgical procedures for low-risk thyroid cancer patients changed following the 2015 ATA guideline revision.
STUDY DESIGN: This retrospective cohort analysis used data from the 2004-2016 National Cancer Database. The International Classification of Diseases for Oncology, third edition, (ICD-O-3) was used to identify thyroid cancer (C73.9) and histological subtypes for PTC, FTC, Hurthle cell carcinoma (HCC), medullary thyroid cancer (MTC), and undifferentiated thyroid carcinoma (UTC). We defined initial treatment as hemithyroidectomy if the patient’s primary surgical site was Surgery identified as lobectomy and/or isthmectomy. Logistic regression was used to estimate the association between the change of the 2015 ATA guideline and hemithyroidectomy utilization among patients with each of the different thyroid cancer types while controlling for Charlson Deyo Score, hospital type, tumor size, and insurance status.
POPULATION STUDIED: A total of 171,563 patients with primary thyroid cancer >1cm and <4cm were included, 16,217 (9.45%) of whom were treated after the publication of the 2015 ATA guideline. Histological subtypes were: 89.23% PTC, 6.01% FTC, 2.57% HCC, 2.05% MTC, and 0.15% UTC.
PRINCIPAL FINDINGS: Patients with PTC who were treated after the publication of the 2015 ATA guideline had 72% greater odds of hemithyroidectomy utilization compared to patients who were treated before the guideline (OR=1.72; p<0.0001), with an increase in hemithyroidectomy utilization from 6.61% in 2014 to 10.14% in 2016 among PTC patients. The change of the guideline was significantly associated with 50% greater odds of hemithyroidectomy utilization among patients with FTC (OR=1.50; p<0.0001), and the hemithyroidectomy utilization among FTC increased from 19.67% in 2014 to 28.05% in 2016. Patients with HCC, MTC, and UTC did not have a significant change in utilization of hemithyroidectomy rate following the publication of the 2015 ATA guideline.
CONCLUSIONS: The publication of the 2015 ATA guideline was significantly associated with increased hemithyroidectomy utilization among patients with PTC and FTC, but it had no significant effect on patients with HCC, MTC, and UTC.
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