Largest Study Ever Conducted on Papillary Thyroid Cancer
Finds Total Thyroid Removal Improves Patient Survival Rates

ACS research addresses long-standing surgical debate;
examines 13 years of data from National Cancer Data Base

CHICAGO: In the largest study on papillary thyroid cancers (PTC) to date, and the first to examine what extent of thyroid surgery results in improved outcomes, American College of Surgeons (ACS) researchers have discovered that total thyroidectomy results in lower recurrence rates and improved survival for patients with tumors that measure greater than 1.0 cm. This is the first study to demonstrate this finding and answers a question that has been debated in the field for 20 years: Does the extent of thyroid cancer surgery affect a patient’s survival rate? And if so, is there a tumor-size threshold that supports total thyroid removal to improve the patient’s chance of survival? The researchers presented study results today at the 127th Annual Meeting of the American Surgical Association (ASA) in Colorado Springs, CO.

To conduct the study, researchers analyzed 13 years of data from the National Cancer Data Base (NCDB), a joint program of the American College of Surgeons Commission on Cancer (CoC) and the American Cancer Society. NCDB is a nationwide oncology outcomes database for more than 1,400 Commission-approved cancer programs in the United States and Puerto Rico, and captures approximately 88 percent of all new thyroid cancers diagnosed annually.

NCDB data in this study accounted for 52,173 patients who underwent surgical procedures for PTC in the United States from 1985 to 1998. Of that group, 43,227 (82.9 percent) underwent total thyroidectomy and 8,946 (17.1 percent) underwent lobectomy. The researchers discovered that when compared to those patients who underwent total thyroidectomy for a 1.0 - 2.0 cm tumor, the lobectomy patients had a 24 percent higher likelihood of cancer recurrence and a 49 percent higher death rate.

“Historically, there has been endless debate surrounding the extent of surgery for PTC, yet a clinical study on this issue would not have been possible,” said David Winchester, MD, FACS, Medical Director, ACS Cancer Programs. “But with the NCDB’s extensive historical data and large sample size, we were able to effectively assess the impact that the extent of surgery has on patient outcomes, and to determine a tumor size threshold above which total thyroid removal results in improved survival rates.”

This is the first study to clearly demonstrate a survival benefit for total thyroidectomy in tumors larger than 1.0 cm, suggesting that the biology of tumors less than 1.0 cm is different from those 1.0 – 2.0 cm, and thus grouping the size categories together may not be appropriate.

“Consensus guidelines have not been able to recommend complete removal of the thyroid based on a survival advantage. This is the first study to demonstrate improved survival for thyroid cancer patients when the entire thyroid gland is removed, as opposed to simply removing the side [of the gland] with cancer,” according to lead author Karl Y. Bilimoria, MD, NCDB Research Fellow, American College of Surgeons, and a general surgery resident at Northwestern University's Feinberg School of Medicine, Chicago, IL.

“These findings are exciting because we finally had a large enough pool of people, over a long enough period of time, to establish definite guidelines for when to recommend near-total or total thyroidectomies to patients to benefit their long-term outcomes,” added Cord Sturgeon, MD, FACS, study co-author, Northwestern University, Department of Surgery, Chicago, IL.

According to the American Cancer Society, approximately 33,550 Americans will be diagnosed with thyroid cancer in 2007—1,530 of whom will die of the disease. Although most patients with PTC have an excellent prognosis, recent studies demonstrate an increasing incidence of PTC, particularly due to the detection of tumors smaller than 2.0 cm. Furthermore, in certain subgroups, mortality rates may be increasing.

"Thyroid disease often involves younger women. Broadly applied total thyroidectomy could produce a normal life expectancy and avoid catastrophic premature death for all patients, especially the young," Dr. Winchester concluded.

In addition to Drs. Bilimoria, Winchester, and Sturgeon, contributing authors include David J. Bentrem, MD, and Mark S. Talamonti, MD, FACS (Northwestern University); Clifford Y. Ko, MD, FACS, (University of California, Los Angeles (UCLA) and VA Greater Los Angeles Healthcare System); and Andrew K. Stewart, MA (American College of Surgeons Commission on Cancer).

The study was supported by the American College of Surgeons Clinical Scholars in Residence program and a research grant from the Northwestern University Department of Surgery.

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The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 71,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.

Online April 26, 2007

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