Margin Positivity and Survival Outcomes: A Review of 14,471 Patients with 1-cm to 4-cm Papillary Thyroid Carcinoma
- 6 January 2021
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 232 (4), 545-550
- https://doi.org/10.1016/j.jamcollsurg.2020.12.018
Abstract
Background Papillary thyroid carcinoma (PTC) comprises the majority of thyroid malignancy, but it is associated with excellent long-term survival. Highly prevalent, with increasing incidence, the optimal operative management for patients with 1- to 4-cm PTC remains unclear. This study determined factors that affect clinical outcomes, including survival, in this patient population. Study Design Patients with 1- to 4-cm PTC, who underwent thyroidectomy between 2004 and 2016, were identified in the National Cancer Database (NCDB). Factors affecting survival, including margin status, extent of resection, operative volume, and institution type, were studied. Outcomes were estimated by Kaplan-Meier and log rank tests. Cox proportional hazard and binary logistic regression analyses identified factors affecting survival as well as margin positivity. Results Of 14,471 patients with 1- to 4-cm PTC, 2,269 (15.7%) exhibited lymphovascular invasion, 6,925 (47.9%) had multifocality, 14,235 (98.3%) underwent total thyroidectomy, and 2,212 (15.3%) had microscopic margin positivity, which conferred lower survival (hazard ratio [HR] 1.464, p < 0.05), with 30-day and 90-day mortality of 0.1% and 0.2%, respectively. Operative volume (odds ratio [OR] 0.979, p < 0.01) and thyroid surgery at an academic center (OR 0.623, p < 0.001) were associated with lower odds of margin positivity. Conclusions In patients with 1- to 4-cm PTC, margin positivity confers lower survival. Factors associated with lower rate of margin positivity are higher operative volume and referral for treatment at academic center. Because margin positivity is a modifiable risk factor, referral of patients with aggressive features of PTC to high volume academic centers may improve survival.Keywords
This publication has 11 references indexed in Scilit:
- Lobectomy Is Feasible for 1–4 cm Papillary Thyroid Carcinomas: A 10-Year Propensity Score Matched-Pair Analysis on RecurrenceThyroid®, 2019
- Oncologic outcomes in patients with 1‐cm to 4‐cm differentiated thyroid carcinoma according to extent of thyroidectomyHead & Neck, 2018
- Positive Surgical Margins in Favorable-Stage Differentiated Thyroid CancerAmerican Journal of Clinical Oncology, 2018
- Impact of Extent of Surgery on Tumor Recurrence and Survival for Papillary Thyroid Cancer PatientsAnnals of Surgical Oncology, 2018
- Thyroid lobectomy is not sufficient for T2 papillary thyroid cancersSurgery, 2018
- Extent of surgery did not affect recurrence during 7-years follow-up in papillary thyroid cancer sized 1-4 cm: Preliminary resultsClinical Endocrinology, 2017
- 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid CancerThyroid®, 2016
- Microscopic Positive Margins in Differentiated Thyroid Cancer Is Not an Independent Predictor of Local FailureThyroid®, 2015
- Extent of Surgery for Papillary Thyroid Cancer Is Not Associated With SurvivalAnnals of Surgery, 2014
- Extent of Surgery Affects Survival for Papillary Thyroid CancerAnnals of Surgery, 2007