Comparison of cancer-specific survival between total thyroidectomy and lobectomy in tall cell variant of papillary thyroid carcinoma

The tall cell variant of papillary thyroid carcinoma (TCV-PTC) is an aggressive subtype with a poorer prognosis. Controversy persists regarding the surgical strategy for TCV-PTC. Using the SEER database (2005–2017), we analyzed 1,463 patients with pathologically confirmed TCV-PTC who underwent either total thyroidectomy (TT) (n = 1,369) or lobectomy (n = 94). Propensity score matching (PSM) was used to address confounding biases. The primary endpoint was cancer-specific survival (CSS), assessed using Kaplan-Meier analysis and Cox regression. After PSM (n = 376), TT demonstrated superior CSS compared to lobectomy (p = 0.019). The 5-year and 10-year CSS for TT were 97.8% and 95.0% versus 90.7% and 89.1% for lobectomy in the matched cohort. This survival benefit of TT persisted regardless of radioiodine therapy (RAI) (p < 0.05). Multivariable analysis identified lobectomy, tumor size > 40 mm, extrathyroidal extension, and lymph node metastasis as independent risk factors for reduced CSS. Total thyroidectomy is associated with improved CSS compared to lobectomy in TCV-PTC, independent of RAI. Greater caution should be considered in selecting lobectomy for TCV patients, especially for patients with tumors > 40 mm, lymph node metastasis, or extrathyroidal extension. Completion thyroidectomy may be beneficial for patients diagnosed with TCV-PTC after lobectomy.