Effect of delayed treatment on survival and prognosis of papillary thyroid microcarcinoma: A large sample real world study based on SEER database_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LENG Ying , DAN Jiaqiang ,  LI Junyan

Department of Thyroid and Breast Surgery, Chengdu Fifth People’s Hospital, Chengdu 611130, P. R. China;

Corresponding author：

LI Junyan, Email: 122809937@qq.com

Keywords：

papillary thyroid microcarcinoma; delayed treatment; disease-specific survival; overall survival

DOI：

10.7507/1007-9424.202312023

Video：

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Objective To use real-world data from a large sample of papillary thyroid microcarcinoma (PTMC) in the SEER database to investigate the impact of delayed treatment on survival outcomes. Methods A total of 40 761 patients with PTMC eligible for the study from the SEER database of the National Cancer Institute of the United States during 2000–2019 were selected as the study objects and divided into 3 groups according to the different delayed treatment time (0, 0–6 months, >6 months). Kaplan-Meir method was used to plot the survival curve and calculate 5-year cumulative disease-specific survival (DSS) rate and overall survival (OS) rate. Cox proportional hazard regression model was used to analyze the relationship between delayed treatment time, DSS and OS in PTMC patients and the influencing factors of prognosis. Results Among the 40 761 patients, 7 575 (18.58%) were males and 33 186 (81.42%) were females, most of whom were females. The patients ranged in age from 3 to 97 years old [ (51.1±13.9) years old], of which 24 043 (58.99%) were <55 years old and 16 718 (41.01%) were ≥55 years old. Received treatment immediately after diagnosis in 30 823 patients (75.62%), 9 734 patients (23.88%) received treatment within 6 months after diagnosis, 204 patients (0.50%) received treatment 6 months after diagnosis. There were significant differences in age, sex, race, lymph node stage, radiotherapy, surgical method, number of lesions and invasion of thyroid capsule among the 3 groups (P< 0.001). The survival analysis results of the 3 groups showed that the delayed treatment time had no effect on DSS and OS of PTMC patients (P>0.05). The multivariate Cox proportional hazard regression model analysis results showed that the patient’s age ≥55 years old, male, married, lymph node metastasis, radiotherapy, total thyroidectomy and thyroid capsule invasion were the risk factors affecting DSS and OS in PTMC patients (P<0.05), while delayed treatment was not risk factors for DSS and OS in PTMC patients (P>0.05). Conclusion Delayed treatment is not an independent risk factor for DSS and OS in patients with PTMC, and active monitoring is a safe alternative to surgery for some PTMCS.

Citation： LENG Ying, DAN Jiaqiang, LI Junyan. Effect of delayed treatment on survival and prognosis of papillary thyroid microcarcinoma: A large sample real world study based on SEER database. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(6): 718-725. doi: 10.7507/1007-9424.202312023 Copy

1.	Pitoia F, Smulever A. Active surveillance in low risk papillary thyroid carcinoma. World J Clin Oncol, 2020, 11(6): 320-336.
2.	Davies L, Morris LG, Haymart M, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: The Increasing Incidence of Thyroid Cancer. Endocr Pract, 2015, 21(6): 686-696.
3.	Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg, 2014, 140(4): 317-322.
4.	Ito Y, Uruno T, Nakano K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid, 2003, 13(4): 381-387.
5.	Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study. Cancer, 1985, 56(3): 531-538.
6.	Ahn HS, Kim HJ, Welch HG. Korea’s thyroid-cancer “epidemic” —creening and overdiagnosis. N Engl J Med, 2014, 371(19): 1765-1767.
7.	Oda H, Miyauchi A, Ito Y, et al. Incidences of unfavorable events in the management of low-risk papillary microcarcinoma of the thyroid by active surveillance versus immediate surgery. Thyroid, 2016, 26(1): 150-155.
8.	Shaha AR, Tuttle RM. Editorial: Risk of disease progression during active surveillance of papillary thyroid cancer. Surgery, 2018, 163(1): 53-54.
9.	Iasonos A, Schrag D, Raj GV, et al. How to build and interpret a nomogram for cancer prognosis. J Clin Oncol, 2008, 26(8): 1364-1370.
10.	Chaves N, Broekhuis JM, Fligor SC, et al. Delay in surgery and papillary thyroid cancer survival in the United States: A SEER-medicare analysis. J Clin Endocrinol Metab, 2023, 108(10): 2589-2596.
11.	中华人民共和国国家卫生健康委员会医政医管局. 甲状腺癌诊疗指南(2022年版). 中国实用外科杂志, 2022, 42(12): 1343-1357, 1363.
12.	Miranda-Filho A, Lortet-Tieulent J, Bray F, et al. Thyroid cancer incidence trends by histology in 25 countries: a population-based study. Lancet Diabetes Endocrinol, 2021, 9(4): 225-234.
13.	Li M, Brito JP, Vaccarella S. Long-term declines of thyroid cancer mortality: An international age-period-cohort analysis. Thyroid, 2020, 30(6): 838-846.
14.	尹经霞, 崔龙, 蒲丹岚, 等. 2023年《甲状腺结节和分化型甲状腺癌诊治指南(第二版)》解读. 现代医药卫生, 2023, 39(8): 1261-1266.
15.	Sugitani I, Fujimoto Y. Symptomatic versus asymptomatic papillary thyroid microcarcinoma: a retrospective analysis of surgical outcome and prognostic factors. Endocr J, 1999, 46(1): 209-216.
16.	Ito Y, Miyauchi A, Kihara M, et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid, 2014, 24(1): 27-34.
17.	Sugitani I, Toda K, Yamada K, et al. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg, 2010, 34(6): 1222-1231.
18.	Luster M, Aktolun C, Amendoeira I, et al. European Perspective on 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: Proceedings of an Interactive International Symposium. Thyroid, 2019, 29(1): 7-26.
19.	Molinaro E, Campopiano MC, Pieruzzi L, et al. Active surveillance in papillary thyroid microcarcinomas is feasible and safe: experience at a single Italian center. J Clin Endocrinol Metab, 2020, 105(3): e172-e180. doi: 10.1210/clinem/dgz113.
20.	Tuttle RM, Fagin JA, Minkowitz G, et al. Natural history and tumor volume kinetics of papillary thyroid cancers during active surveillance. JAMA Otolaryngol Head Neck Surg, 2017, 143(10): 1015-1020.
21.	Hu YL, Cao XY, Zhou YR, et al. Management of sonographically suspicious thyroid nodules 1 cm or smaller and candidacy for active surveillance: experience of a tertiary center in China. Endocr Pract, 2021, 27(9): 903-911.
22.	Rosato L, Avenia N, Bernante P, et al. Complications of thyroid surgery: analysis of a multicentric study on 14 934 patients operated on in Italy over 5 years. World J Surg, 2004, 28(3): 271-276.
23.	Hartl DM, Mamelle E, Borget I, et al. Influence of prophylactic neck dissection on rate of retreatment for papillary thyroid carcinoma. World J Surg, 2013, 37(8): 1951-1958.
24.	Lubitz CC, Kong CY, McMahon PM, et al. Annual financial impact of well-differentiated thyroid cancer care in the United States. Cancer, 2014, 120(9): 1345-1352.
25.	Oda H, Miyauchi A, Ito Y, et al. Comparison of the costs of active surveillance and immediate surgery in the management of low-risk papillary microcarcinoma of the thyroid. Endocr J, 2017, 64(1): 59-64.
26.	Lang BH, Wong CK. A cost-effectiveness comparison between early surgery and non-surgical approach for incidental papillary thyroid microcarcinoma. Eur J Endocrinol, 2015, 173(3): 367-375.
27.	Sugitani I, Ito Y, Takeuchi D, et al. Indications and strategy for active surveillance of adult low-risk papillary thyroid microcarcinoma: Consensus statements from the Japan Association of Endocrine Surgery Task Force on Management for Papillary Thyroid Microcarcinoma. Thyroid, 2021, 31(2): 183-192.
28.	Horiguchi K, Yoshida Y, Iwaku K, et al. Position paper from the Japan Thyroid Association task force on the management of low-risk papillary thyroid microcarcinoma (T1aN0M0) in adults. Endocr J, 2021, 68(7): 763-780.
29.	Ito Y, Miyauchi A. Active surveillance of low-risk papillary thyroid microcarcinomas. Gland Surg, 2020, 9(5): 1663-1673.
30.	彭颖, 程若川. 中国CACA甲状腺癌指南(2022版)外科视角解读. 西安交通大学学报(医学版), 2024, 45(1): 28-34.
31.	Nickel B, Brito JP, Barratt A, et al. Clinicians’ Views on management and terminology for papillary thyroid microcarcinoma: A qualitative study. Thyroid, 2017, 27(5): 661-671.
32.	Ito Y, Miyauchi A, Kudo T, et al. Trends in the implementation of active surveillance for low-risk papillary thyroid microcarcinomas at Kuma hspital: Gradual increase and heterogeneity in the acceptance of this new management option. Thyroid, 2018, 28(4): 488-495.

1. Pitoia F, Smulever A. Active surveillance in low risk papillary thyroid carcinoma. World J Clin Oncol, 2020, 11(6): 320-336.
2. Davies L, Morris LG, Haymart M, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: The Increasing Incidence of Thyroid Cancer. Endocr Pract, 2015, 21(6): 686-696.
3. Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg, 2014, 140(4): 317-322.
4. Ito Y, Uruno T, Nakano K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid, 2003, 13(4): 381-387.
5. Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study. Cancer, 1985, 56(3): 531-538.
6. Ahn HS, Kim HJ, Welch HG. Korea’s thyroid-cancer “epidemic” —creening and overdiagnosis. N Engl J Med, 2014, 371(19): 1765-1767.
7. Oda H, Miyauchi A, Ito Y, et al. Incidences of unfavorable events in the management of low-risk papillary microcarcinoma of the thyroid by active surveillance versus immediate surgery. Thyroid, 2016, 26(1): 150-155.
8. Shaha AR, Tuttle RM. Editorial: Risk of disease progression during active surveillance of papillary thyroid cancer. Surgery, 2018, 163(1): 53-54.
9. Iasonos A, Schrag D, Raj GV, et al. How to build and interpret a nomogram for cancer prognosis. J Clin Oncol, 2008, 26(8): 1364-1370.
10. Chaves N, Broekhuis JM, Fligor SC, et al. Delay in surgery and papillary thyroid cancer survival in the United States: A SEER-medicare analysis. J Clin Endocrinol Metab, 2023, 108(10): 2589-2596.
11. 中华人民共和国国家卫生健康委员会医政医管局. 甲状腺癌诊疗指南(2022年版). 中国实用外科杂志, 2022, 42(12): 1343-1357, 1363.
12. Miranda-Filho A, Lortet-Tieulent J, Bray F, et al. Thyroid cancer incidence trends by histology in 25 countries: a population-based study. Lancet Diabetes Endocrinol, 2021, 9(4): 225-234.
13. Li M, Brito JP, Vaccarella S. Long-term declines of thyroid cancer mortality: An international age-period-cohort analysis. Thyroid, 2020, 30(6): 838-846.
14. 尹经霞, 崔龙, 蒲丹岚, 等. 2023年《甲状腺结节和分化型甲状腺癌诊治指南(第二版)》解读. 现代医药卫生, 2023, 39(8): 1261-1266.
15. Sugitani I, Fujimoto Y. Symptomatic versus asymptomatic papillary thyroid microcarcinoma: a retrospective analysis of surgical outcome and prognostic factors. Endocr J, 1999, 46(1): 209-216.
16. Ito Y, Miyauchi A, Kihara M, et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid, 2014, 24(1): 27-34.
17. Sugitani I, Toda K, Yamada K, et al. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg, 2010, 34(6): 1222-1231.
18. Luster M, Aktolun C, Amendoeira I, et al. European Perspective on 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: Proceedings of an Interactive International Symposium. Thyroid, 2019, 29(1): 7-26.
19. Molinaro E, Campopiano MC, Pieruzzi L, et al. Active surveillance in papillary thyroid microcarcinomas is feasible and safe: experience at a single Italian center. J Clin Endocrinol Metab, 2020, 105(3): e172-e180. doi: 10.1210/clinem/dgz113.
20. Tuttle RM, Fagin JA, Minkowitz G, et al. Natural history and tumor volume kinetics of papillary thyroid cancers during active surveillance. JAMA Otolaryngol Head Neck Surg, 2017, 143(10): 1015-1020.
21. Hu YL, Cao XY, Zhou YR, et al. Management of sonographically suspicious thyroid nodules 1 cm or smaller and candidacy for active surveillance: experience of a tertiary center in China. Endocr Pract, 2021, 27(9): 903-911.
22. Rosato L, Avenia N, Bernante P, et al. Complications of thyroid surgery: analysis of a multicentric study on 14 934 patients operated on in Italy over 5 years. World J Surg, 2004, 28(3): 271-276.
23. Hartl DM, Mamelle E, Borget I, et al. Influence of prophylactic neck dissection on rate of retreatment for papillary thyroid carcinoma. World J Surg, 2013, 37(8): 1951-1958.
24. Lubitz CC, Kong CY, McMahon PM, et al. Annual financial impact of well-differentiated thyroid cancer care in the United States. Cancer, 2014, 120(9): 1345-1352.
25. Oda H, Miyauchi A, Ito Y, et al. Comparison of the costs of active surveillance and immediate surgery in the management of low-risk papillary microcarcinoma of the thyroid. Endocr J, 2017, 64(1): 59-64.
26. Lang BH, Wong CK. A cost-effectiveness comparison between early surgery and non-surgical approach for incidental papillary thyroid microcarcinoma. Eur J Endocrinol, 2015, 173(3): 367-375.
27. Sugitani I, Ito Y, Takeuchi D, et al. Indications and strategy for active surveillance of adult low-risk papillary thyroid microcarcinoma: Consensus statements from the Japan Association of Endocrine Surgery Task Force on Management for Papillary Thyroid Microcarcinoma. Thyroid, 2021, 31(2): 183-192.
28. Horiguchi K, Yoshida Y, Iwaku K, et al. Position paper from the Japan Thyroid Association task force on the management of low-risk papillary thyroid microcarcinoma (T1aN0M0) in adults. Endocr J, 2021, 68(7): 763-780.
29. Ito Y, Miyauchi A. Active surveillance of low-risk papillary thyroid microcarcinomas. Gland Surg, 2020, 9(5): 1663-1673.
30. 彭颖, 程若川. 中国CACA甲状腺癌指南(2022版)外科视角解读. 西安交通大学学报(医学版), 2024, 45(1): 28-34.
31. Nickel B, Brito JP, Barratt A, et al. Clinicians’ Views on management and terminology for papillary thyroid microcarcinoma: A qualitative study. Thyroid, 2017, 27(5): 661-671.
32. Ito Y, Miyauchi A, Kudo T, et al. Trends in the implementation of active surveillance for low-risk papillary thyroid microcarcinomas at Kuma hspital: Gradual increase and heterogeneity in the acceptance of this new management option. Thyroid, 2018, 28(4): 488-495.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of delayed treatment on survival and prognosis of papillary thyroid microcarcinoma: A large sample real world study based on SEER database

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