Timing of Thyroidectomy Does Not Affect Overall Survival in Papillary Thyroid Carcinoma

Yoon, D.; Caesar-Peterson, S.; Wang, C.; Halimi, M.; Ahmed, L.; Prinz, R. A.; Suman, P.

Introduction: Appropriate timing of definitive thyroidectomy after diagnosis of papillary thyroid carcinoma (PTC) is not well-defined. We analyzed the impact of timing of thyroidectomy on overall survival (OS) in PTC. Methods: The National Cancer Data Base was queried from 2004 to 2012 for biopsy-proven >1 cm cN0M0 PTC undergoing thyroidectomy without radioactive iodine. Timing of surgery was categorized in <1 month, 1-2 months, 2-3 months and 3-6 months. Kaplan-Meier, Cox and propensity-score matched survival analyses were performed after adjusting for patient and tumor-related categories. Results: Among 6,664 patients with PTC size >1 cm, 2,765 (41.5%), 2,500 (37.5%), 899 (13.5%) and 500 (7.5%) patients had thyroidectomy in <1 month, 1-2 months, 2-3 months and 3-6 months respectively. Multivariate analysis demonstrated higher mortality risk in older patients (>55 years), males and >2 cm tumors (P<0.05). Kaplan-Meier analysis did not show significant difference in OS for different time categories (P=.591). After adjusting for demographics, socioeconomic and tumor related variables, thyroidectomy between 1-2 months (HR.781, 95% CI.573-1.066, P=.119), 2-3 months (HR 1.123, 95% CI.751-1.681, P=.571) and 3-6 months (HR 1.093, CI.662-1.804, P=.728) did not affect OS when compared to surgery at <1 month. A propensity-score matched comparison between timing of surgery at <2 and >2 months failed to show a long-term mortality difference (P=.409). Conclusion: The timing of thyroidectomy from diagnosis of PTC does not affect OS in >1 cm PTC. Study results can be utilized in making an informed decision about thyroidectomy during the current COVID pandemic.