Risk Factors That Influence Surgical Decision-Making for Patients with Low-Risk Differentiated Thyroid Cancer with Tumor Diameters of 1–4 cm

Abstract

Xiangming Wang,1,* Chao Zhang,1,* Akanksha Srivastava,2 Wenbin Yu,3,* Chuan Liu,4 Dongmin Wei,5 Yuncheng Li,6 Jianming Yang1 1Department of Otolaryngology Head and Neck Surgery, The Second Hospital of Anhui Medical University, Hefei, People’s Republic of China; 2Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA; 3Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, People’s Republic of China; 4Department of Otorhinolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 5Department of Otorhinolaryngology, Qilu Hospital of Shandong University, Shandong, People’s Republic of China; 6Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jianming YangDepartment of Otolaryngology Head and Neck Surgery, The Second Hospital of Anhui Medical University, Hefei 230601, People’s Republic of ChinaTel +86 551 63869515Email jmyang88@163.comYuncheng LiDepartment of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People’s Republic of ChinaEmail whxhent30@163.comBackground: There are several controversies between thyroid lobectomy and total thyroidectomy for surgical management of low-risk differentiated thyroid cancer (DTC) with a tumor diameter of 1– 4 cm.Patients and Methods: In this study, we explore the factors related to selection of type of surgical procedure for 103 low-risk DTC patients with a tumor diameter of 1– 4 cm.Results: Among 103 low-risk DTC patients with tumor diameters of 1– 4 cm, 43 patients underwent total thyroidectomy and 60 patients underwent thyroid lobectomy based on postoperative pathology. A ROC curve showed that the optimal diagnostic threshold for selecting surgical modality was a tumor diameter of 2.15 cm. For these low-risk DTC patients, the sensitivity and specificity for predicting thyroid lobectomy when tumor diameter < 2.15 cm while total thyroidectomy when tumor diameter ≥ 2.15 cm are 46.5% and 78.3%, respectively. There were significant differences between the selection of type of surgical procedure in patient groups with 1) tumors with multiple foci group vs a single focus (P< 0.05), and 2) tumor diameter of ≥ 2.15 cm vs < 2.15 cm (P< 0.05). There was no significant difference between gender and age groups (P> 0.05). Multivariate analysis confirmed that tumors with multiple foci and diameter ≥ 2.15 cm were the primary risk factors for implementation of total thyroidectomy (P< 0.05).Conclusion: The diameter and multifocal nature of low-risk DTC tumors are the primary factors related to preferred surgical modality. This study revealed that thyroid lobectomy is more applicable to patients with tumor diameter < 2.15 cm and a single focus, whereas, total thyroidectomy was preferred in patients with tumor diameter ≥ 2.15 cm and/or multiple foci.Keywords: differentiated thyroid cancer, cancer metastasis, operation type, factor analysis

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