A single institution experience with papillary thyroid cancer: Are outcomes better at comprehensive cancer centers?
Papillary thyroid cancer (PTC) is the most common form of thyroid cancer. Although the survival rate is excellent, recurrence is as high as 20%. The mainstay of therapy is thyroidectomy and lymph node dissection based on risk factors. Data from other cancers suggest that surgical outcomes are most o...
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| Veröffentlicht in: | The American journal of surgery 2021-10, Vol.222 (4), p.802-805 |
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| creator | Aryanpour, Zain Asban, Ammar Boyd, Carter Herring, Brendon Eustace, Nicholas Carmona Matos, Danilea M. McCaw, Tyler Ramonell, Kimberly M. Fazendin, Jessica M. Lindeman, Brenessa Iyer, Pallavi Chen, Herbert |
| description | Papillary thyroid cancer (PTC) is the most common form of thyroid cancer. Although the survival rate is excellent, recurrence is as high as 20%. The mainstay of therapy is thyroidectomy and lymph node dissection based on risk factors. Data from other cancers suggest that surgical outcomes are most optimal at comprehensive cancer centers. We hypothesize that patients with PTC who had their initial operation at a comprehensive cancer center would have a better oncologic outcome.
We utilized an IRB-approved cancer care registry database of patients with thyroid cancer who were seen at our institution between 2000 and 2018. Patient records were updated with cancer-specific outcomes including recurrence and need for re-intervention. Clinical and surgical outcomes were then compared between patients who had their initial operation at a comprehensive cancer center (CCC group, n = 503) versus those who did not (non-CCC group, n = 72).
Mean patient age was 49 ± 16 years and 70% were female. Average tumor size was 1.6 ± 1.6 cm. There was no difference in tumor size, age, gender or race between groups. Pre-operative ultrasound was more frequently performed at the CCC (89%) than at non-CCC’s (51%, p |
| doi_str_mv | 10.1016/j.amjsurg.2021.02.027 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8408279</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002961021001094</els_id><sourcerecordid>2499000296</sourcerecordid><originalsourceid>FETCH-LOGICAL-c495t-96a9435109d5e4944a48655f7c9e2be5d6e59db7d94a0d19f0b326550008710b3</originalsourceid><addsrcrecordid>eNqFkU2LFDEQhoMo7uzqT1ACXrzMmKSTTuLBZVjWD1jwoueQTtfMpOnutEl6dP-9aWdc1ItQEIp6UlVvvQi9oGRDCa3fdBs7dGmO-w0jjG4IKyEfoRVVUq-pUtVjtCKEsLWuKblAlyl1JaWUV0_RRVXVspZMrFDa4uTHfQ_Yjyn7PGcfRgw_JogeRgf4u88HPNnJ972N9zgf7mPwLXa2FONbvI2Aw5xdGCDhBnKGiG3GJZ8iHGBM_ghnGDsYSzldP0NPdrZP8Pz8XqGv72-_3Hxc333-8Olme7d2XItcFreaV4IS3QrgmnPLVS3ETjoNrAHR1iB028hWc0taqnekqVgBikwlaUmu0LtT32luBmiX8dH2Zop-KFJMsN78XRn9wezD0ShOFJO6NHh9bhDDtxlSNoNPDsolRghzMoxrvdxY1wV99Q_ahTmORZ5hQjKluOSyUOJEuRhSirB7WIYSs9hqOnO21Sy2GsJKLP9e_qnk4ddvHwtwfQKg3PPoIZrkfvnX-ggumzb4_4z4CX-tuJs</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2572884747</pqid></control><display><type>article</type><title>A single institution experience with papillary thyroid cancer: Are outcomes better at comprehensive cancer centers?</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Aryanpour, Zain ; Asban, Ammar ; Boyd, Carter ; Herring, Brendon ; Eustace, Nicholas ; Carmona Matos, Danilea M. ; McCaw, Tyler ; Ramonell, Kimberly M. ; Fazendin, Jessica M. ; Lindeman, Brenessa ; Iyer, Pallavi ; Chen, Herbert</creator><creatorcontrib>Aryanpour, Zain ; Asban, Ammar ; Boyd, Carter ; Herring, Brendon ; Eustace, Nicholas ; Carmona Matos, Danilea M. ; McCaw, Tyler ; Ramonell, Kimberly M. ; Fazendin, Jessica M. ; Lindeman, Brenessa ; Iyer, Pallavi ; Chen, Herbert</creatorcontrib><description>Papillary thyroid cancer (PTC) is the most common form of thyroid cancer. Although the survival rate is excellent, recurrence is as high as 20%. The mainstay of therapy is thyroidectomy and lymph node dissection based on risk factors. Data from other cancers suggest that surgical outcomes are most optimal at comprehensive cancer centers. We hypothesize that patients with PTC who had their initial operation at a comprehensive cancer center would have a better oncologic outcome.
We utilized an IRB-approved cancer care registry database of patients with thyroid cancer who were seen at our institution between 2000 and 2018. Patient records were updated with cancer-specific outcomes including recurrence and need for re-intervention. Clinical and surgical outcomes were then compared between patients who had their initial operation at a comprehensive cancer center (CCC group, n = 503) versus those who did not (non-CCC group, n = 72).
Mean patient age was 49 ± 16 years and 70% were female. Average tumor size was 1.6 ± 1.6 cm. There was no difference in tumor size, age, gender or race between groups. Pre-operative ultrasound was more frequently performed at the CCC (89%) than at non-CCC’s (51%, p < 0.001). CCC patients were more likely to undergo initial total thyroidectomies compared to non-CCC patients (76% vs. 21%, p < 0.001). Positive surgical margins were more frequently found in patients at non-CCC’s (19%) than at the CCC (9.7%, p = 0.016). Finally, CCC patients had a significantly lower cancer recurrence rate (5.0% vs. 37.5%, p < 0.001). Therefore, the need for additional cancer operations was much greater in patients who had initial thyroid surgery at non-CCC (31.9% vs. 1.4%, p < 0.001).
Patients with PTC who have their initial thyroidectomy at non-CCC have higher recurrence rates, higher rates of positive tumor margins on pathology, and increased need for additional operations. These data suggest that patients who have their initial procedure at a CCC for PTC have better long-term outcomes.
•Patients with PTC who have their thyroid surgery at an NCI-designated comprehensive cancer center have lower recurrence rates, less need for additional operations, and less positive margins on surgical pathology.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2021.02.027</identifier><identifier>PMID: 33676725</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Cancer ; Cancer Care Facilities - statistics & numerical data ; Collaboration ; Comprehensive cancer center ; Female ; Hospitals ; Humans ; Lymph Node Excision ; Lymph nodes ; Male ; Margins of Excision ; Medical prognosis ; Medical research ; Middle Aged ; Mortality ; NCI ; Neoplasm Recurrence, Local ; Outcome Assessment, Health Care ; Papillary thyroid cancer ; Patients ; Reoperation - statistics & numerical data ; Risk analysis ; Risk factors ; Surgery ; Surgery outcomes ; Surgical outcomes ; Surveillance ; Survival ; Thyroid ; Thyroid cancer ; Thyroid Cancer, Papillary - diagnostic imaging ; Thyroid Cancer, Papillary - pathology ; Thyroid Cancer, Papillary - surgery ; Thyroidectomy ; Thyroidectomy - standards ; Tumors ; Ultrasonic imaging ; Ultrasonography</subject><ispartof>The American journal of surgery, 2021-10, Vol.222 (4), p.802-805</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><rights>2021. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c495t-96a9435109d5e4944a48655f7c9e2be5d6e59db7d94a0d19f0b326550008710b3</citedby><cites>FETCH-LOGICAL-c495t-96a9435109d5e4944a48655f7c9e2be5d6e59db7d94a0d19f0b326550008710b3</cites><orcidid>0000-0002-7581-5744 ; 0000-0002-2483-7863 ; 0000-0001-5154-5455 ; 0000-0002-5328-0726 ; 0000-0002-1421-6852 ; 0000-0003-2923-6079</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002961021001094$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33676725$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aryanpour, Zain</creatorcontrib><creatorcontrib>Asban, Ammar</creatorcontrib><creatorcontrib>Boyd, Carter</creatorcontrib><creatorcontrib>Herring, Brendon</creatorcontrib><creatorcontrib>Eustace, Nicholas</creatorcontrib><creatorcontrib>Carmona Matos, Danilea M.</creatorcontrib><creatorcontrib>McCaw, Tyler</creatorcontrib><creatorcontrib>Ramonell, Kimberly M.</creatorcontrib><creatorcontrib>Fazendin, Jessica M.</creatorcontrib><creatorcontrib>Lindeman, Brenessa</creatorcontrib><creatorcontrib>Iyer, Pallavi</creatorcontrib><creatorcontrib>Chen, Herbert</creatorcontrib><title>A single institution experience with papillary thyroid cancer: Are outcomes better at comprehensive cancer centers?</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Papillary thyroid cancer (PTC) is the most common form of thyroid cancer. Although the survival rate is excellent, recurrence is as high as 20%. The mainstay of therapy is thyroidectomy and lymph node dissection based on risk factors. Data from other cancers suggest that surgical outcomes are most optimal at comprehensive cancer centers. We hypothesize that patients with PTC who had their initial operation at a comprehensive cancer center would have a better oncologic outcome.
We utilized an IRB-approved cancer care registry database of patients with thyroid cancer who were seen at our institution between 2000 and 2018. Patient records were updated with cancer-specific outcomes including recurrence and need for re-intervention. Clinical and surgical outcomes were then compared between patients who had their initial operation at a comprehensive cancer center (CCC group, n = 503) versus those who did not (non-CCC group, n = 72).
Mean patient age was 49 ± 16 years and 70% were female. Average tumor size was 1.6 ± 1.6 cm. There was no difference in tumor size, age, gender or race between groups. Pre-operative ultrasound was more frequently performed at the CCC (89%) than at non-CCC’s (51%, p < 0.001). CCC patients were more likely to undergo initial total thyroidectomies compared to non-CCC patients (76% vs. 21%, p < 0.001). Positive surgical margins were more frequently found in patients at non-CCC’s (19%) than at the CCC (9.7%, p = 0.016). Finally, CCC patients had a significantly lower cancer recurrence rate (5.0% vs. 37.5%, p < 0.001). Therefore, the need for additional cancer operations was much greater in patients who had initial thyroid surgery at non-CCC (31.9% vs. 1.4%, p < 0.001).
Patients with PTC who have their initial thyroidectomy at non-CCC have higher recurrence rates, higher rates of positive tumor margins on pathology, and increased need for additional operations. These data suggest that patients who have their initial procedure at a CCC for PTC have better long-term outcomes.
•Patients with PTC who have their thyroid surgery at an NCI-designated comprehensive cancer center have lower recurrence rates, less need for additional operations, and less positive margins on surgical pathology.</description><subject>Cancer</subject><subject>Cancer Care Facilities - statistics & numerical data</subject><subject>Collaboration</subject><subject>Comprehensive cancer center</subject><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Lymph Node Excision</subject><subject>Lymph nodes</subject><subject>Male</subject><subject>Margins of Excision</subject><subject>Medical prognosis</subject><subject>Medical research</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>NCI</subject><subject>Neoplasm Recurrence, Local</subject><subject>Outcome Assessment, Health Care</subject><subject>Papillary thyroid cancer</subject><subject>Patients</subject><subject>Reoperation - statistics & numerical data</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Surgery</subject><subject>Surgery outcomes</subject><subject>Surgical outcomes</subject><subject>Surveillance</subject><subject>Survival</subject><subject>Thyroid</subject><subject>Thyroid cancer</subject><subject>Thyroid Cancer, Papillary - diagnostic imaging</subject><subject>Thyroid Cancer, Papillary - pathology</subject><subject>Thyroid Cancer, Papillary - surgery</subject><subject>Thyroidectomy</subject><subject>Thyroidectomy - standards</subject><subject>Tumors</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU2LFDEQhoMo7uzqT1ACXrzMmKSTTuLBZVjWD1jwoueQTtfMpOnutEl6dP-9aWdc1ItQEIp6UlVvvQi9oGRDCa3fdBs7dGmO-w0jjG4IKyEfoRVVUq-pUtVjtCKEsLWuKblAlyl1JaWUV0_RRVXVspZMrFDa4uTHfQ_Yjyn7PGcfRgw_JogeRgf4u88HPNnJ972N9zgf7mPwLXa2FONbvI2Aw5xdGCDhBnKGiG3GJZ8iHGBM_ghnGDsYSzldP0NPdrZP8Pz8XqGv72-_3Hxc333-8Olme7d2XItcFreaV4IS3QrgmnPLVS3ETjoNrAHR1iB028hWc0taqnekqVgBikwlaUmu0LtT32luBmiX8dH2Zop-KFJMsN78XRn9wezD0ShOFJO6NHh9bhDDtxlSNoNPDsolRghzMoxrvdxY1wV99Q_ahTmORZ5hQjKluOSyUOJEuRhSirB7WIYSs9hqOnO21Sy2GsJKLP9e_qnk4ddvHwtwfQKg3PPoIZrkfvnX-ggumzb4_4z4CX-tuJs</recordid><startdate>20211001</startdate><enddate>20211001</enddate><creator>Aryanpour, Zain</creator><creator>Asban, Ammar</creator><creator>Boyd, Carter</creator><creator>Herring, Brendon</creator><creator>Eustace, Nicholas</creator><creator>Carmona Matos, Danilea M.</creator><creator>McCaw, Tyler</creator><creator>Ramonell, Kimberly M.</creator><creator>Fazendin, Jessica M.</creator><creator>Lindeman, Brenessa</creator><creator>Iyer, Pallavi</creator><creator>Chen, Herbert</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7581-5744</orcidid><orcidid>https://orcid.org/0000-0002-2483-7863</orcidid><orcidid>https://orcid.org/0000-0001-5154-5455</orcidid><orcidid>https://orcid.org/0000-0002-5328-0726</orcidid><orcidid>https://orcid.org/0000-0002-1421-6852</orcidid><orcidid>https://orcid.org/0000-0003-2923-6079</orcidid></search><sort><creationdate>20211001</creationdate><title>A single institution experience with papillary thyroid cancer: Are outcomes better at comprehensive cancer centers?</title><author>Aryanpour, Zain ; Asban, Ammar ; Boyd, Carter ; Herring, Brendon ; Eustace, Nicholas ; Carmona Matos, Danilea M. ; McCaw, Tyler ; Ramonell, Kimberly M. ; Fazendin, Jessica M. ; Lindeman, Brenessa ; Iyer, Pallavi ; Chen, Herbert</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c495t-96a9435109d5e4944a48655f7c9e2be5d6e59db7d94a0d19f0b326550008710b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Cancer</topic><topic>Cancer Care Facilities - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aryanpour, Zain</au><au>Asban, Ammar</au><au>Boyd, Carter</au><au>Herring, Brendon</au><au>Eustace, Nicholas</au><au>Carmona Matos, Danilea M.</au><au>McCaw, Tyler</au><au>Ramonell, Kimberly M.</au><au>Fazendin, Jessica M.</au><au>Lindeman, Brenessa</au><au>Iyer, Pallavi</au><au>Chen, Herbert</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A single institution experience with papillary thyroid cancer: Are outcomes better at comprehensive cancer centers?</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2021-10-01</date><risdate>2021</risdate><volume>222</volume><issue>4</issue><spage>802</spage><epage>805</epage><pages>802-805</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>Papillary thyroid cancer (PTC) is the most common form of thyroid cancer. Although the survival rate is excellent, recurrence is as high as 20%. The mainstay of therapy is thyroidectomy and lymph node dissection based on risk factors. Data from other cancers suggest that surgical outcomes are most optimal at comprehensive cancer centers. We hypothesize that patients with PTC who had their initial operation at a comprehensive cancer center would have a better oncologic outcome.
We utilized an IRB-approved cancer care registry database of patients with thyroid cancer who were seen at our institution between 2000 and 2018. Patient records were updated with cancer-specific outcomes including recurrence and need for re-intervention. Clinical and surgical outcomes were then compared between patients who had their initial operation at a comprehensive cancer center (CCC group, n = 503) versus those who did not (non-CCC group, n = 72).
Mean patient age was 49 ± 16 years and 70% were female. Average tumor size was 1.6 ± 1.6 cm. There was no difference in tumor size, age, gender or race between groups. Pre-operative ultrasound was more frequently performed at the CCC (89%) than at non-CCC’s (51%, p < 0.001). CCC patients were more likely to undergo initial total thyroidectomies compared to non-CCC patients (76% vs. 21%, p < 0.001). Positive surgical margins were more frequently found in patients at non-CCC’s (19%) than at the CCC (9.7%, p = 0.016). Finally, CCC patients had a significantly lower cancer recurrence rate (5.0% vs. 37.5%, p < 0.001). Therefore, the need for additional cancer operations was much greater in patients who had initial thyroid surgery at non-CCC (31.9% vs. 1.4%, p < 0.001).
Patients with PTC who have their initial thyroidectomy at non-CCC have higher recurrence rates, higher rates of positive tumor margins on pathology, and increased need for additional operations. These data suggest that patients who have their initial procedure at a CCC for PTC have better long-term outcomes.
•Patients with PTC who have their thyroid surgery at an NCI-designated comprehensive cancer center have lower recurrence rates, less need for additional operations, and less positive margins on surgical pathology.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33676725</pmid><doi>10.1016/j.amjsurg.2021.02.027</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0002-7581-5744</orcidid><orcidid>https://orcid.org/0000-0002-2483-7863</orcidid><orcidid>https://orcid.org/0000-0001-5154-5455</orcidid><orcidid>https://orcid.org/0000-0002-5328-0726</orcidid><orcidid>https://orcid.org/0000-0002-1421-6852</orcidid><orcidid>https://orcid.org/0000-0003-2923-6079</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Cancer Cancer Care Facilities - statistics & numerical data Collaboration Comprehensive cancer center Female Hospitals Humans Lymph Node Excision Lymph nodes Male Margins of Excision Medical prognosis Medical research Middle Aged Mortality NCI Neoplasm Recurrence, Local Outcome Assessment, Health Care Papillary thyroid cancer Patients Reoperation - statistics & numerical data Risk analysis Risk factors Surgery Surgery outcomes Surgical outcomes Surveillance Survival Thyroid Thyroid cancer Thyroid Cancer, Papillary - diagnostic imaging Thyroid Cancer, Papillary - pathology Thyroid Cancer, Papillary - surgery Thyroidectomy Thyroidectomy - standards Tumors Ultrasonic imaging Ultrasonography |
| title | A single institution experience with papillary thyroid cancer: Are outcomes better at comprehensive cancer centers? |
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