American Surgical Association

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Should All Papillary Thyroid Microcarcinomas Be Aggressively Treated? An Analysis of 18,445 Cases
Xiao-Min Yu, MD*, Yin Wan, MD*, Rebecca Sippel, MD*, Herbert Chen, MD
University of Wisconsin, Madison, WI

OBJECTIVE(S): The management of papillary thyroid microcarcinomas(PTMC) is controversial, and ranges from observation to total thyroidectomy. The lack of consensus is predominantly due to the general excellent overall prognosis thereby requiring a large cohort to delineate differences in outcome. The purpose of this study was to identify risk factors which predict PTMC-related death in a large patient population to determine which patients need aggressive treatment.
METHODS: All papillary thyroid cancer patients with tumor size <= 1cm in the Surveillance, Epidemiology and End Results (SEER) Cancer Database from 1988 to 2007 were identified. Outcomes including overall and disease-specific survival were compared, and different risk groups were evaluated by multivariate analysis.
RESULTS: A total of 18,445 cases of PTMC with surgery were identified. The 10-year and 15-year overall survivals were 94.6% and 90.7%, respectively, while disease-specific survivals were 99.5% and 99.3%. Older age than 45years, male gender, African-American or minority race, node metastases, extrathyroidal invasion and distant metastases were stratified to be significant risk factors for overall survival. There were 49 thyroid cancer-related deaths. Forty-five (92%) out of 49 patients had at least two risk factors, and 51% of these 49 patients had three or more risk factors (vs. 5.7% in the rest of the cohort, p<0.001).
CONCLUSIONS: Though PTMC is generally associated with an excellent prognosis, 0.5% patients may die of PTMC. The presence of 2 or more risk factors is strongly associated with cancer-related mortality and can help to identify patients that should be considered for more aggressive surgical management.


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