Thyroid : official journal of the American Thyroid Association · 2026
A Temporal Analysis of Surgical Management and Outcomes Following ATA Guideline Updates in Papillary Thyroid Carcinoma: A Real-World Cohort Study of 31,861 Patients in South Korea.
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Ryu Jae Sang, Kim Eun Jin, Lee In A, Kim Dong Wook, Lee Ji An, Seo Dong Hyun, Park Ji Ahn, Park Sunmi, Kang Sungkeun, Kang Sang Wook, Jeong Jong Ju, Nam Kee Hyun, Chung Woong Youn, Jo Young Suk, Lee Jandee
Аннотация
BACKGROUND: The American Thyroid Association (ATA) guideline revisions in 2009 and 2015 encouraged a shift toward less extensive surgery and reduced use of radioactive iodine (RAI) in the management of patients with low-risk papillary thyroid carcinoma (PTC). The aim of this study was to evaluate the real-world impact of these guideline changes on treatment patterns, complications, and oncologic outcomes.
METHODS: In this retrospective cohort study conducted at a high-volume tertiary center in South Korea, we analyzed 31,861 patients treated for PTCs measuring ≤4 cm during 2004-2020. Patients were stratified into three temporal cohorts (triad 0 2004-2009; triad 1: 2010-2015; and triad 2: 2016-2020), and exact matching was performed to balance clinicopathologic characteristics across the groups. Segmented regression analysis was used to identify treatment pattern shifts. Postoperative complications and disease-free survival (DFS) were compared across the matched cohorts by using conditional logistic and stratified Cox regression analyses. Five-year restricted mean survival time (RMST) analysis was performed to adjust for follow-up variation.
RESULTS: After guideline implementation, total thyroidectomies and RAI use significantly declined. Permanent hypocalcemia decreased from 2.7% to 0.2% (p < 0.001) while transient complications remained stable. Although recurrence rates were lowest in the most recent era (1.3%), DFS analysis revealed higher hazard ratios for recurrence in triad 2 versus earlier cohorts (triad 2 vs. 0 hazard ratio: 1.520, confidence interval: 1.160-1.980). However, 5-year DFS and RMST comparisons revealed no significant differences.
CONCLUSIONS: ATA guideline-driven de-escalation strategies were successfully implemented in real-world practice in this study, reducing overtreatment and surgical morbidity without compromising short-term oncologic outcomes.
METHODS: In this retrospective cohort study conducted at a high-volume tertiary center in South Korea, we analyzed 31,861 patients treated for PTCs measuring ≤4 cm during 2004-2020. Patients were stratified into three temporal cohorts (triad 0 2004-2009; triad 1: 2010-2015; and triad 2: 2016-2020), and exact matching was performed to balance clinicopathologic characteristics across the groups. Segmented regression analysis was used to identify treatment pattern shifts. Postoperative complications and disease-free survival (DFS) were compared across the matched cohorts by using conditional logistic and stratified Cox regression analyses. Five-year restricted mean survival time (RMST) analysis was performed to adjust for follow-up variation.
RESULTS: After guideline implementation, total thyroidectomies and RAI use significantly declined. Permanent hypocalcemia decreased from 2.7% to 0.2% (p < 0.001) while transient complications remained stable. Although recurrence rates were lowest in the most recent era (1.3%), DFS analysis revealed higher hazard ratios for recurrence in triad 2 versus earlier cohorts (triad 2 vs. 0 hazard ratio: 1.520, confidence interval: 1.160-1.980). However, 5-year DFS and RMST comparisons revealed no significant differences.
CONCLUSIONS: ATA guideline-driven de-escalation strategies were successfully implemented in real-world practice in this study, reducing overtreatment and surgical morbidity without compromising short-term oncologic outcomes.