Management of Very Elderly Patients With Papillary Thyroid Cancer: Analysis of Outcomes for Surgery Versus Nonsurgery

J Surg Res. 2020 Dec:256:512-519. doi: 10.1016/j.jss.2020.07.017. Epub 2020 Aug 13.

Abstract

Background: The prognosis of patients with papillary thyroid cancer (PTC) who have undergone surgery is usually good. But surgery is risky for elderly patients. The outcomes of surgery or nonsurgery for the very elderly PTC patients have not been reported. Here, we investigated the effect of surgery or not on prognosis in very elderly PTC patients (aged ≥85 y).

Methods: A retrospective study was performed based on data from the Surveillance, Epidemiology, and End Results program. The outcomes of surgery and nonsurgery in very elderly PTC patients were compared using different statistical methods, including propensity score matching.

Results: A total of 1196 very elderly patients with PTC were enrolled in the study. Patients who underwent surgery (n = 871) had a much better prognosis than those who did not (n = 325) in both overall survival and cancer-specific survival (P < 0.001). In the multivariate analysis, nonsurgery was an independent predictor for both overall survival (hazard ratio = 2.066; P < 0.001) and cancer-specific survival (hazard ratio = 2.768; P < 0.001).

Conclusions: Surgery is positively associated with an improved prognosis of PTC patients aged ≥85 y and is still suggested for these patients after appropriate risk assessment.

Keywords: Age; Elderly patient; Papillary thyroid cancer; Surgery; Survival.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged, 80 and over
  • Clinical Decision-Making*
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Neoplasm Grading
  • Prognosis
  • Retrospective Studies
  • Risk Assessment / statistics & numerical data
  • Risk Factors
  • SEER Program / statistics & numerical data
  • Thyroid Cancer, Papillary / mortality
  • Thyroid Cancer, Papillary / pathology
  • Thyroid Cancer, Papillary / surgery*
  • Thyroid Gland / pathology
  • Thyroid Gland / surgery
  • Thyroid Neoplasms / mortality
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / surgery*
  • Thyroidectomy / adverse effects
  • Thyroidectomy / statistics & numerical data*
  • Treatment Outcome