Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Sanziana A. Roman

Second Advisor

Julie A. Sosa

Subject Area(s)

Surgery, Medicine

Abstract

CENTRAL LYMPH NODE DISSECTION IN PATIENTS WITH PAPILLARY THYROID CANCER: A POPULATION LEVEL ANALYSIS OF 14,257 CASES. Chineme Enyioha, Sanziana Roman and Julie Ann Sosa. Department of Surgery, Yale School of Medicine, New Haven, CT.

The role of prophylactic central lymph node dissection (CLND) in patients with differentiated thyroid cancer has been controversial. This study analyzes the impact of patient demographic factors and tumor size on surgery with CLND in patients with papillary thyroid cancer (PTC) in the U.S.

All patients >/= 18 with PTC and follicular variant-PTC, who underwent thyroidectomy with or without CLND in SEER, 2004-08, were included. Bivariate and multivariate analyses were performed to determine effects of patient demographic and clinical characteristics on the likelihood of undergoing CLND.

Of 14,257 patients in the study, 80.3% were women, 84.3% white, and the average age was 50.1 years. 79.6% had a total thyroidectomy, and 37.1% had a CLND. Bivariate analysis revealed that patients who were older, black, and from the South were less likely to undergo CLND (all p<. 001). Patients with T1 tumors were least likely to undergo CLND (36.6% compared to 57.2% of T4 tumors, p<. 01). 32.1% of patients with 2 cm had CLND, of which 3.6% (microPTC) and 8.8% (tumors 1-2cm) had positive nodes compared to 34.2% of patients with T4 tumors. From 2004 to 2008, there was an 18.3% increase in overall use of CLND. On multivariate analysis, younger age, female gender, white race, and Northeast region were independently associated with an increased likelihood of undergoing CLND.

While the use of CLND has increased over time even in patients with T1 tumors, several demographic factors remain associated with lower likelihood of receiving CLND. This variation in practice suggests potential disparity in access and quality of surgical care for PTC in the U.S.

Comments

This is an Open Access Thesis.

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