Reassessing surgical guidelines for papillary thyroid cancer impact on survival: Expanding indications for lobectomy.
Reassessing surgical guidelines for papillary thyroid cancer impact on survival: Expanding indications for lobectomy.
复制标题
重新评估甲状腺乳头状癌手术指南对生存的影响：扩大肺叶切除术的适应症。
DOI：
10.1016/j.surg.2023.05.033
复制
发表时间：
2023
期刊：
影响因子：
3.8
通讯作者：
Balentine,Courtney
中科院分区：
文献类型：
--
作者：
Stevens,Audrey;Meier,Jennie;Bhat,Archana;Knight,SaraJ;Vanness,DavidJ;Balentine,Courtney
背景 甲状腺乳头状癌的肺叶切除术与甲状腺全切除术的比较尚未解决对观察数据的有效推论的重大威胁。本研究的目的是比较甲状腺乳头状癌的肺叶切除术与甲状腺全切除术后的生存率，同时解决未测量的混杂因素带来的偏差。方法这项回顾性队列研究纳入了 2004 年至 2017 年国家癌症数据库中 84,300 名因乳头状甲状腺癌接受肺叶切除术或甲状腺全切除术治疗的患者。主要结果是通过灵活的参数生存模型和倾向评分的逆概率加权评估总体生存率。使用双向确定性敏感性分析和两阶段最小二乘回归来评估未观察到的混杂因素带来的偏差。结果治疗患者的中位年龄为 48 岁（四分位数范围，37-59），78% 为女性，76% 为白人。我们发现接受肺叶切除术或甲状腺全切除术治疗的患者的总生存率或 5 年和 10 年生存率没有统计学上的显着差异。此外，我们发现亚组的生存率没有统计学上的显着差异，包括肿瘤大小（<4厘米或≥4厘米）、年龄（<65岁或≥65岁）或估计死亡风险。敏感性分析表明，未测量的混杂因素需要产生极大的影响才能改变主要发现。结论这是第一项比较肺叶切除术和甲状腺全切除术结果的研究，同时调整和量化未测量的混杂变量对观察数据的潜在影响。研究结果表明，无论肿瘤大小、患者年龄或总体死亡风险如何，甲状腺全切除术不太可能比肺叶切除术提供生存优势。
BackgroundComparisons of lobectomy versus total thyroidectomy for papillary thyroid cancer have not addressed significant threats to valid inference from observational data. The purpose of this study was to compare survival after lobectomy versus total thyroidectomy for papillary thyroid cancer while addressing bias from unmeasured confounding.MethodsThis retrospective cohort study included 84,300 patients treated with lobectomy or total thyroidectomy for papillary thyroid cancer in the National Cancer Database from 2004 to 2017. The primary outcome was overall survival evaluated by flexible parametric survival models and inverse probability weighting on the propensity score. Bias from unobserved confounding was assessed using two-way deterministic sensitivity analysis and 2-stage least squares regression.ResultsThe median age of treated patients was 48 years (interquartile range, 37–59), 78% were women, and 76% were white. We found no statistically significant differences in overall survival or 5- and 10-year survival between patients treated with lobectomy or total thyroidectomy. Additionally, we found no statistically significant difference in survival by subgroups, including tumor size (<4 cm or ≥4 cm), age (<65 or ≥65), or estimated risk of mortality. Sensitivity analyses suggested that an unmeasured confounder would need to have an extremely large effect to change the primary finding.ConclusionThis is the first study to compare lobectomy and total thyroidectomy outcomes while adjusting for and quantifying the potential effects of unmeasured confounding variables on observational data. The findings suggest that total thyroidectomy is unlikely to offer a survival advantage over lobectomy regardless of tumor size, patient age, or overall risk of death.