The following is a summary of “Delay in Surgery and Papillary Thyroid Cancer Survival in the United States: A SEER-Medicare Analysis ,” published in the October 2023 issue of Endocrinology by Chaves, et al.
The influence of surgical delays on the survival of patients with papillary thyroid cancer (PTC) remains uncertain. For a study, researchers sought to explore the association between the time elapsed before surgery and survival outcomes in individuals diagnosed with PTC.
A cohort of 8,170 Medicare beneficiaries with PTC, who underwent thyroidectomy was identified from the Surveillance, Epidemiology, and End Results-Medicare linked data files spanning from 1999 to 2018. Disease-specific survival (DSS) and overall survival (OS) were assessed using Kaplan-Meir analysis. Cox proportional hazard models were employed to estimate the relationship between the duration of time to surgery and survival outcomes.
Among the 8,170 patients with PTC, with a mean age of 69.3 (SD±/-11.4), 89.8% underwent surgery within the initial 90 days, 7.8% had surgery between 91 and 180 days from diagnosis, and 2.4% underwent surgery after 180 days. An increase in time to surgery was associated with elevated mortality in the group with delays exceeding 180 days for OS (adjusted hazard ratio [aHR] 1.24; 95% CI, 1.01-1.53). Stratification by summary stage revealed a 25% increased risk in the 91- to 180-day group (aHR 1.25; 95% CI, 1.05-1.51) and a 61% increased risk in those with delays over 180 days (aHR 1.61; 95% CI, 1.19-2.18) for OS in localized disease. The >180-day group with localized disease had nearly four times the estimated rate of DSS mortality (aHR 3.51; 95% CI, 1.68-7.32). When stratified by T stage, those with T2 disease in the >180-day group exhibited double the estimated rate of all-cause mortality (aHR 2.0; 95% CI, 1.1-3.3) and almost triple the estimated rate of disease-specific mortality (aHR 2.7; 95% CI, 1.05-6.8).
The study suggested that delays in surgery for PTC may impact both overall and disease-specific survival, particularly in cases of localized disease before nodal metastasis.