Access to Surgery and Outcomes for Papillary Thyroid Cancer Following the 2015 American Thyroid Association Guideline Changes

Background The extent of surgical treatment for intermediate-sized (1.0-4.0 cm) papillary thyroid cancer (PTC) has been widely debated. This study evaluates the impact of the 2015 ATA guidelines on the surgical treatment trends of intermediate-sized PTC tumors. Methods Using the Surveillance, Epidemiology, and End Results (SEER) database, patients with intermediate-sized PTC tumors were separated into pre-ATA guideline changes (2000-2015) or post-ATA changes (2016-2020) groupings. Lobectomy or total thyroidectomy usage was compared with logistic regression analyses. Results The rate of lobectomy increased from a mean usage rate of 10.0% pre-ATA updates to 18.6% post-guideline changes ( P < 0.001). Logistic regression showed the rate of thyroidectomy decreased post-ATA changes ( P < 0.001, odds ratio (OR) = 0.607). Additionally, total thyroidectomy was associated with improved survival ( P < 0001, HR = 0.624) and); tumors sized 2.1 cm-3.0 cm ( P < 0001, HR = 1.824) and 3.1 cm-4.0 cm ( P < 0001, HR = 2.927) were associated with worse survival. Conclusions After the 2015 ATA guideline changes there has been a significant increase in the rate of lobectomy for intermediate-sized PTC tumors occurred after the 2015 ATA guideline changes, reflecting the guidelines supporting less aggressive surgical management in low-risk cases.