Prognostic Impact of Surgical Extent in N1a-Stage Differentiated Thyroid Cancer: SEER Matched Analysis

Prognostic Impact of Surgical Extent in N1a-Stage Differentiated Thyroid Cancer: SEER Matched Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prognostic Impact of Surgical Extent in N1a-Stage Differentiated Thyroid Cancer: SEER Matched Analysis Ziying Liu, Ziyou Lin, Minjue Shan, Bin Wang, Senyan Hu, Kai Shen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7209352/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To compare the prognosis of patients with differentiated thyroid cancer (DTC) in N1a stage following partial versus total resection. Methods: This study included patients aged 15 to 79 years diagnosed with N1a stage DTC, as per the 6th edition of the American Joint Committee on Cancer (AJCC) staging system, from 2004 to 2015. Exclusion criteria were: unknown ethnicity, M1 stage (6th edition AJCC), UNK stage group, pathological types such as anaplastic or medullary carcinoma, and indeterminate surgical extent. Cases were matched at a 3:1 ratio (total to partial thyroidectomy) based on a standard deviation difference in age of ≤0.01, an age discrepancy of ≤3 years, and identical T and overall stages. Survival analysis was conducted using the Kaplan-Meier method, and survival curves were generated. The log-rank and Breslow tests compared outcomes between groups. Cox proportional hazards regression model assessed the independent predictive capacity of variables, with a significance threshold of P<0.05. Conclusion: In balanced matched cases, the type of surgical intervention in patients with DTC in N1a stage did not significantly influence disease-specific survival (DSS; P=0.072). However, a significant effect on overall survival (OS) was noted ( P <0.05). differentiated thyroid cancer N1a partial thyroidectomy total thyroidectomy prognosis Figures Figure 1 Figure 2 Figure 3 1. Instruction Thyroid cancer represents one of the most prevalent malignant tumors globally, with its incidence rising markedly over recent decades. DTC, comprising papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC), constitutes approximately 95% of all thyroid cancers. The primary curative strategy for thyroid cancer is surgical treatment, and the United Kingdom National Multidisciplinary Guidelines underscore the pivotal role of surgery in the diagnosis, staging, and management of this disease(1). Research indicates that PTC patients who decline surgery experience worse survival outcomes(2). For DTC, however, the selection of a surgical approach significantly influences patient prognosis(3). Recent clinical data suggest that DTC patients eligible for complete surgical resection exhibit lower recurrence rates, improved intraoperative metrics, and fewer complications compared to those undergoing partial thyroidectomy(4). Therefore, selecting an appropriate surgical technique is crucial for minimizing intraoperative risks and enhancing postoperative survival rates and quality of life for DTC patients(5,6). Improper surgical strategies can exacerbate patient discomfort and financial burden, highlighting the importance of careful surgical decision-making for DTC patients. The N1a stage denotes thyroid cancer patients with central lymph node metastases but no distant metastases. These patients face a substantially higher risk of recurrence than those without lymph node metastases(2)and have lower survival rates(7). The choice of surgical methods for N1a stage thyroid cancer remains contentious, largely due to the need to consider various factors, including patient age, tumor size, and lymph node metastasis. This study explores the link between the extent of surgical resection and the prognosis of DTC patients in the N1a stage. It aims to provide crucial insights for selecting clinical surgical approaches and is expected to contribute evidence for addressing ongoing debates in clinical practice, thus fostering the advancement of personalized treatment plans. 2. Materials and methods 2.1 Research data SEER*Stat software was utilized to retrieve and extract data on patients diagnosed with differentiated thyroid tumors from 2004 to 2015. Diagnoses were made according to the International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3), and TNM staging was conducted based on the 6th edition AJCC guidelines. The SEER database used in this study is public, and all patient information has been anonymized; therefore, ethical review was not required,consistent with methodologies employed in prior SEER-based studies( 8 ). 2.2 Patient Selection 2.2.1Inclusion Criteria Patients diagnosed with DTC between 2004 and 2015, classified under ICD-O-3/WHO 2008 codes, staged as N1a according to the 6th edition AJCC staging system, and aged between 15 and 79 years were included. 2.2.2Exclusion Criteria Patients with unknown ethnicity, M1 stage, UNK stage, anaplastic carcinoma or medullary carcinoma, unknown cancer type, or unclear surgical extent were excluded. 2.2.3Selection of Information The selected information included age, sex, race, TNM stage, grade stage, type of surgery, survival time, and prognosis at diagnosis. 2.3 Case-Cohort Study Due to a significant disparity in the number of cases between partial and total thyroidectomy and the presence of numerous non-research-related confounding factors, case matching was necessary to eliminate the influence of these factors. The standard deviation of age difference was maintained at no more than 0.01, with an age gap controlled within 3 years; T stage and overall stage were required to be consistent; and a 3:1 ratio of total to partial thyroidectomy cases was maintained for matching. 2.4 Endpoint SEER cause-specific death classification indicates whether an individual died from this tumor. Classification of total survival and death encompasses mortality from various causes. Data for this study were obtained from the SEER research database, covering the period from 1975 to 2020. Although the SEER database does not directly report causes of death, its definitions cover various causes of death based on ICD-8 to ICD-10 codes. Additionally, the database has been updated to include additional anatomical sites of hematopoietic tumors and their distinct classifications. 2.5 Survival Time Each case has a specific study cutoff date, and survival months are capped at this date. For patients who died after the study cutoff date, their survival time is recorded as the number of months from the diagnosis date to the study cutoff date. The study cutoff date is typically set as the last calendar day of each diagnostic year. If a patient died before the study cutoff date, their survival months were calculated precisely using the SEER survival time calculation formula. 2.6 Statistical Analysis Data extracted from the SEER database were imported using RStudio, and the composition of relevant factors was displayed using the table function. Data meeting the exclusion criteria were removed using the subset function. SPSS27.0 software was used for statistical analysis. Continuous variables from matched case data were expressed by median, average, and percentile, and the Mann-Whitney test was applied. Categorical data were represented by the number of cases and percentage, and the Pearson chi-square test was utilized for analysis. Survival analysis was conducted using the Kaplan-Meier method, and survival curves were plotted. Intergroup comparisons were performed using the log-rank test and Breslow test. Additionally, the independent predictive performance of variables was assessed using the Cox proportional hazards regression model, with a significance threshold of P < 0.05. To further optimize sample matching, future studies might consider employing more complex matching methods such as propensity score matching (PSM) to reduce bias caused by case number imbalance.This analytical framework aligns with established methodologies for survival analysis in oncology( 9 ). 3. Results 3.1Patient Screening Process and Matching Results The case selection process is depicted in Figure 1. Initially, 4,664 cases diagnosed with DTC between 2004 and 2015 were identified from the SEER database. These cases were within the age range of 15 to 79 years and classified under the 6th edition AJCC N stage of N1a. After applying a series of exclusion criteria, 4,455 patient cases remained. These cases were subsequently matched according to predefined methods, resulting in a final cohort of 684 DTC cases. This cohort maintained controlled variables including age, T stage, and overall stage. Among these, 513 cases underwent total thyroidectomy, and 171 cases underwent partial thyroidectomy. 3.2Characteristics of Patients After Balance Matching The clinical characteristics of the patients after balance matching are presented in Table 1. Table 1 Comparison of clinical characteristics of patients after balance matching surgical approach partial excision (0) total excision (1) clinical features case % case % U P Age (mean ± SD) 47.3 15.7 47.3 15.6 0.976 Total 171 100% 513 100% Gender 0.592 female male 119 52 69.6% 30.4% 368 145 71.7% 28.3% Race 0.510 caucasian melanoderm others 140 2 29 81.9% 1.2% 17.0% 399 6 108 77.8% 1.2% 21.1% Stage 0.995 I III IV 75 86 10 43.9% 50.3% 5.8% 224 258 31 43.7% 50.3% 6.0% T stage T 0 T 1 T 2 T 3 T 4 T X 2 83 26 45 12 3 1.2% 48.5% 15.2% 26.3% 7.0% 1.8% 2 252 79 137 40 3 0.4% 49.1% 15.4% 26.7% 7.8% 0.6% 0.630* * a. In this table, more than 20% of the cells have expected cell counts less than 5. The chi-square results may be invalid. b. In this table, the minimum expected cell count is less than 1. The chi-square results may be invalid. Regarding gender distribution, the partial resection group consisted of 69.6% females and 30.4% males, while the total resection group consisted of 71.7% females and 28.3% males. No statistically significant difference was observed between the two groups (P=0.592). In terms of age, the mean age was 47.25 years with a standard deviation of 15.633 in the partial resection group, and 47.3 years with a standard deviation of 15.697 in the total resection group. The age distributions were similar, with no statistically significant difference (U=0.976). Regarding racial distribution, the partial resection group included 81.9% Caucasians, 1.2% African Americans, and 17.0% other races, whereas the total resection group included 77.8% Caucasians, 1.2% African Americans, and 21.1% other races. The racial distributions were balanced, with no statistically significant difference (chi-square value=0.510). Concerning stage distribution, the partial resection group encompassed 43.9% stage I, 50.3% stage III, and 5.8% stage IV cases, while the total resection group encompassed 43.7% stage I, 50.3% stage III, and 6.0% stage IV cases. The stage distributions were consistent, with no statistically significant difference (P=0.995). Regarding T-stage distribution, the partial resection group included 1.2% T0, 48.5% T1, 15.2% T2, 26.3% T3, 7.0% T4, and 1.8% TX cases, while the total resection group included 0.4% T0, 49.1% T1, 15.4% T2, 26.7% T3, 7.8% T4, and 0.6% TX cases. The T-stage distributions were generally similar, although slight differences were noted in the T0 and TX categories ( P =0.630). 3.3 Comparison of Surgical Prognosis The prognostic efficacy of total thyroidectomy versus partial thyroidectomy was rigorously evaluated through disease-specific survival (DSS) and overall survival (OS) analyses. Table 2 presents the DSS outcomes, which reveal no statistically significant difference between the partial resection cohort (mean DSS: 203.6±3.4 months) and the total resection cohort (mean DSS: 209.3±1.2 months; P=0.096). Despite a hazard ratio (HR) of 2.007, indicating a trend toward inferior DSS in the partial resection group, this association did not reach statistical significance. The overlapping survival curves in Figure 2 further corroborate the lack of a definitive DSS advantage for either surgical modality, suggesting comparable disease-specific mortality outcomes. In contrast, Table 3 demonstrates a statistically significant OS benefit favoring total thyroidectomy. The total resection cohort exhibited a mean OS of 198.1±2.2 months, markedly surpassing the 186.9±5.0 months observed in the partial resection cohort (P=0.037; HR = 1.650). The distinct separation of OS curves in Figure 3 visually underscores this divergence, suggesting that total resection offers systemic survival benefits beyond direct oncological control. Notably, the disparity in OS outcomes may be attributed to reduced recurrence-driven secondary interventions (such as reoperation risks) and optimized postoperative metabolic management (including standardized thyroid hormone supplementation), which collectively reduce non-cancer morbidity and enhance long-term survival in a population with favorable cancer-specific prognosis 3.4 Prognostic Correlations of Survival Outcomes Multivariable Cox regression models for DSS and OS are summarized in Table 4. Age was identified as a significant independent prognostic factor for both DSS (HR = 1.136 per year, 95% CI: 1.062–1.215, P < 0.001) and OS (HR = 1.085 per year, 95% CI: 1.052–1.119, P < 0.001), with each additional year associated with an increased mortality risk. Total thyroidectomy demonstrated divergent effects: while it showed a non-significant trend toward improved DSS (HR = 0.384, 95% CI: 0.135–1.089, P = 0.072), it significantly reduced overall mortality risk by 44.1% (OS: HR = 0.559, 95% CI: 0.323–0.969, P = 0.038). Advanced T-stage exhibited a borderline association with DSS (HR = 1.751, 95% CI: 0.991–3.092, P = 0.054), but not with OS (HR = 1.247, 95% CI: 0.947–1.642, P = 0.116), suggesting that tumor invasiveness primarily drives cancer-specific mortality. Variables such as race, gender, and overall stage showed no significant associations with either endpoint (P > 0.05). 4 Discussion In this study, we assessed the prognostic differences between partial and total resection surgeries in patients with stage N1a differentiated thyroid cancer (DTC) using conditionally matched cases from the SEER database. Our results revealed no statistically significant difference in disease-specific survival (DSS) between the two surgical approaches (P = 0.072). However, total resection was associated with significantly improved overall survival (OS) compared to partial resection (P = 0.038). Furthermore, Cox regression analysis identified age as a common risk factor for both DSS and OS, while the surgical modality emerged as an independent protective factor exclusively for OS (HR = 0.559). These findings provide novel, evidence-based insights into the optimal surgical strategy for stage N1a DTC patients and highlight the complexity of prognostic evaluation when considering different survival endpoints. Total thyroidectomy (TT) offers the advantage of reducing the risk of residual disease, as it ensures complete thyroid tissue removal. Previous studies have reported lower recurrence rates following TT( 10 ). Additionally, TT minimizes the need for subsequent surgeries, which may involve complications such as recurrent laryngeal nerve injury and hypoparathyroidism( 11 ). Our data support these findings, demonstrating significantly better OS for TT patients (P = 0.037), potentially due to fewer recurrence-driven complications( 12 ). Furthermore, postoperative management following total thyroidectomy (TT), particularly with levothyroxine (LT4) therapy, plays a crucial role in improving survival. Evidence suggests that well-controlled TSH levels following TT significantly reduce cardiovascular risk( 13 ), especially among younger populations( 14 ), thereby contributing to improved long-term survival. This aligns with our observation that TT patients experienced better overall survival (OS), potentially due to optimized metabolic functions and reduced cardiovascular risks. The literature suggests that TT, compared to partial resection, may improve survival in certain high-risk patients, likely due to better TSH control and optimization of metabolic function( 15 , 16 ). The lack of significant DSS differences between the two surgical approaches may reflect the relatively short follow-up period in this study. Thyroid cancer recurrence can occur more than 10 years after surgery, and our median follow-up duration of 5 years may not have been sufficient to capture long-term disease-specific mortality. The study demonstrated that the cumulative incidence of recurrence in patients with papillary thyroid cancer (PTC) was 18% at 10 years and 26% at 15 years, supporting the need for longer follow-up periods( 17 ). Future studies with longer follow-up durations and larger cohorts are necessary to confirm the potential benefits of TT on DSS. Our analysis also identified age as a key prognostic factor for both DSS and OS, consistent with previous research indicating that age-related declines in immune function and treatment tolerance significantly impact survival outcomes( 18 , 19 ). Notably, for patients with N1a-stage DTC, total thyroidectomy appears to offer a more substantial benefit in OS, particularly by preventing recurrence-related complications and enhancing the management of comorbidities. In terms of clinical implications, the decision between partial and total thyroidectomy should be individualized based on patient-specific factors, including age, comorbidities, and preferences. While TT provides a survival benefit for many patients, partial thyroidectomy may still be appropriate for low-risk patients with adequate postoperative surveillance. This study is limited by the retrospective nature of the SEER database and the absence of molecular data, which could further refine prognostic models. Additionally, the predominantly Caucasian patient population may limit the generalizability of the findings. Future prospective studies should incorporate molecular profiling and longer follow-up to provide more comprehensive insights into the long-term effects of surgical approaches on survival outcomes. Furthermore, research into the role of adjuvant therapies, such as radioactive iodine and targeted therapies, is essential to fully understand their impact when combined with different surgical strategies( 20 ). 5. Conclusion This study highlights the benefits of total resection surgery in improving overall survival (OS) in patients with stage N1a differentiated thyroid cancer (DTC) through rigorous case-matching and multifactorial analysis, providing valuable evidence to support clinical decision-making. However, to optimize surgical indications within the framework of precision medicine, it is crucial to integrate individual patient characteristics and emerging therapeutic modalities. Moving forward, the individualization of thyroid cancer treatment should be further advanced through multicenter collaboration and molecular profiling, aimed at refining treatment strategies and improving patient outcomes. Declarations Consent for Publication Consent for publication is not applicable. Funding This work was supported by the Jiangsu Provincial Double-Innovation Doctor Program [Grant number: 2020-30097], and the Suqian Sci&Tech Program (KY202401). Declaration of Competing Interest The authors declare no conflicts of interest regarding the publication of this paper. Data availability The source of datasets supporting the conclusions are included in this article. Human Ethics and Consent to Participate declarations : not applicable Clinical trial number not applicable. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7209352","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":504831681,"identity":"a6f19a64-7dda-4316-8f17-091fd942520f","order_by":0,"name":"Ziying Liu","email":"","orcid":"","institution":"Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"Ziying","middleName":"","lastName":"Liu","suffix":""},{"id":504831682,"identity":"dcaebe2f-bb54-47c4-9bcd-5cf99d42aaa2","order_by":1,"name":"Ziyou Lin","email":"","orcid":"","institution":"Tongji 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06:12:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":132886,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of DSS Curves Between Partial and Total Resection for Patients with DTC in N1a Stage.\u003c/p\u003e\n\u003cp\u003eLegend: The DSS curve, with the abscissa representing survival months and the ordinate representing cumulative survival rate, illustrates the survival curves of the two groups.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7209352/v1/c6ef885a568c690804be10ba.png"},{"id":89979869,"identity":"7ca04ad3-1292-45bf-bbf3-15e57dd177d6","added_by":"auto","created_at":"2025-08-27 06:20:39","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":135576,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of OS Curves Between Partial and Total Resection for Patients with DTC in N1a Stage.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7209352/v1/fad8206d10f34e7ed24e4d1f.png"},{"id":92091586,"identity":"d7becfd1-b5a3-4897-8cfc-0247f94768b8","added_by":"auto","created_at":"2025-09-24 13:47:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":921459,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7209352/v1/a2c1e34b-a078-4784-96f6-e6ec20ace90e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prognostic Impact of Surgical Extent in N1a-Stage Differentiated Thyroid Cancer: SEER Matched Analysis","fulltext":[{"header":"1. Instruction","content":"\u003cp\u003eThyroid cancer represents one of the most prevalent malignant tumors globally, with its incidence rising markedly over recent decades. DTC, comprising papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC), constitutes approximately 95% of all thyroid cancers. The primary curative strategy for thyroid cancer is surgical treatment, and the United Kingdom National Multidisciplinary Guidelines underscore the pivotal role of surgery in the diagnosis, staging, and management of this disease(1). Research indicates that PTC patients who decline surgery experience worse survival outcomes(2). For DTC, however, the selection of a surgical approach significantly influences patient prognosis(3). Recent clinical data suggest that DTC patients eligible for complete surgical resection exhibit lower recurrence rates, improved intraoperative metrics, and fewer complications compared to those undergoing partial thyroidectomy(4). Therefore, selecting an appropriate surgical technique is crucial for minimizing intraoperative risks and enhancing postoperative survival rates and quality of life for DTC patients(5,6). Improper surgical strategies can exacerbate patient discomfort and financial burden, highlighting the importance of careful surgical decision-making for DTC patients.\u003c/p\u003e\n\u003cp\u003eThe N1a stage denotes thyroid cancer patients with central lymph node metastases but no distant metastases. These patients face a substantially higher risk of recurrence than those without lymph node metastases(2)and have lower survival rates(7). The choice of surgical methods for N1a stage thyroid cancer remains contentious, largely due to the need to consider various factors, including patient age, tumor size, and lymph node metastasis.\u003c/p\u003e\n\u003cp\u003eThis study explores the link between the extent of surgical resection and the prognosis of DTC patients in the N1a stage. It aims to provide crucial insights for selecting clinical surgical approaches and is expected to contribute evidence for addressing ongoing debates in clinical practice, thus fostering the advancement of personalized treatment plans.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Research data\u003c/h2\u003e\u003cp\u003eSEER*Stat software was utilized to retrieve and extract data on patients diagnosed with differentiated thyroid tumors from 2004 to 2015. Diagnoses were made according to the International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3), and TNM staging was conducted based on the 6th edition AJCC guidelines. The SEER database used in this study is public, and all patient information has been anonymized; therefore, ethical review was not required,consistent with methodologies employed in prior SEER-based studies(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Patient Selection\u003c/h2\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e2.2.1Inclusion Criteria\u003c/h2\u003e\u003cp\u003ePatients diagnosed with DTC between 2004 and 2015, classified under ICD-O-3/WHO 2008 codes, staged as N1a according to the 6th edition AJCC staging system, and aged between 15 and 79 years were included.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.2.2Exclusion Criteria\u003c/h2\u003e\u003cp\u003ePatients with unknown ethnicity, M1 stage, UNK stage, anaplastic carcinoma or medullary carcinoma, unknown cancer type, or unclear surgical extent were excluded.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e2.2.3Selection of Information\u003c/h2\u003e\u003cp\u003eThe selected information included age, sex, race, TNM stage, grade stage, type of surgery, survival time, and prognosis at diagnosis.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Case-Cohort Study\u003c/h2\u003e\u003cp\u003eDue to a significant disparity in the number of cases between partial and total thyroidectomy and the presence of numerous non-research-related confounding factors, case matching was necessary to eliminate the influence of these factors. The standard deviation of age difference was maintained at no more than 0.01, with an age gap controlled within 3 years; T stage and overall stage were required to be consistent; and a 3:1 ratio of total to partial thyroidectomy cases was maintained for matching.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Endpoint\u003c/h2\u003e\u003cp\u003eSEER cause-specific death classification indicates whether an individual died from this tumor.\u003c/p\u003e\u003cp\u003eClassification of total survival and death encompasses mortality from various causes. Data for this study were obtained from the SEER research database, covering the period from 1975 to 2020. Although the SEER database does not directly report causes of death, its definitions cover various causes of death based on ICD-8 to ICD-10 codes. Additionally, the database has been updated to include additional anatomical sites of hematopoietic tumors and their distinct classifications.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Survival Time\u003c/h2\u003e\u003cp\u003eEach case has a specific study cutoff date, and survival months are capped at this date. For patients who died after the study cutoff date, their survival time is recorded as the number of months from the diagnosis date to the study cutoff date. The study cutoff date is typically set as the last calendar day of each diagnostic year. If a patient died before the study cutoff date, their survival months were calculated precisely using the SEER survival time calculation formula.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Statistical Analysis\u003c/h2\u003e\u003cp\u003eData extracted from the SEER database were imported using RStudio, and the composition of relevant factors was displayed using the table function. Data meeting the exclusion criteria were removed using the subset function. SPSS27.0 software was used for statistical analysis. Continuous variables from matched case data were expressed by median, average, and percentile, and the Mann-Whitney test was applied. Categorical data were represented by the number of cases and percentage, and the Pearson chi-square test was utilized for analysis. Survival analysis was conducted using the Kaplan-Meier method, and survival curves were plotted. Intergroup comparisons were performed using the log-rank test and Breslow test. Additionally, the independent predictive performance of variables was assessed using the Cox proportional hazards regression model, with a significance threshold of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. To further optimize sample matching, future studies might consider employing more complex matching methods such as propensity score matching (PSM) to reduce bias caused by case number imbalance.This analytical framework aligns with established methodologies for survival analysis in oncology(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1Patient Screening Process and Matching Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe case selection process is depicted in Figure 1. Initially, 4,664 cases diagnosed with DTC between 2004 and 2015 were identified from the SEER database. These cases were within the age range of 15 to 79 years and classified under the 6th edition AJCC N stage of N1a. After applying a series of exclusion criteria, 4,455 patient cases remained. These cases were subsequently matched according to predefined methods, resulting in a final cohort of 684 DTC cases. This cohort maintained controlled variables including age, T stage, and overall stage. Among these, 513 cases underwent total thyroidectomy, and 171 cases underwent partial thyroidectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2Characteristics of Patients After Balance Matching\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe clinical characteristics of the patients after balance matching are presented in Table 1.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"598\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" style=\"width: 598px;\"\u003e\n \u003cp\u003eTable 1 Comparison of clinical characteristics of patients after balance matching\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 280px;\"\u003e\n \u003cp\u003esurgical approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 139px;\"\u003e\n \u003cp\u003epartial excision (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 141px;\"\u003e\n \u003cp\u003etotal excision (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eclinical features\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003ecase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003ecase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eAge (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e47.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e47.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e0.976\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 545px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e69.6%\u003c/p\u003e\n \u003cp\u003e30.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e368\u003c/p\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e71.7%\u003c/p\u003e\n \u003cp\u003e28.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 545px;\"\u003e\n \u003cp\u003eRace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.510\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003ecaucasian\u003c/p\u003e\n \u003cp\u003emelanoderm\u003c/p\u003e\n \u003cp\u003eothers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e81.9%\u003c/p\u003e\n \u003cp\u003e1.2%\u003c/p\u003e\n \u003cp\u003e17.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e399\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e77.8%\u003c/p\u003e\n \u003cp\u003e1.2%\u003c/p\u003e\n \u003cp\u003e21.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 545px;\"\u003e\n \u003cp\u003eStage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.995\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e43.9%\u003c/p\u003e\n \u003cp\u003e50.3%\u003c/p\u003e\n \u003cp\u003e5.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e224\u003c/p\u003e\n \u003cp\u003e258\u003c/p\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e43.7%\u003c/p\u003e\n \u003cp\u003e50.3%\u003c/p\u003e\n \u003cp\u003e6.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eT stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eT\u003csub\u003e0\u003c/sub\u003e\u003c/p\u003e\n \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e\n \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e\n \u003cp\u003eT\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e\n \u003cp\u003eT\u003csub\u003eX\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.2%\u003c/p\u003e\n \u003cp\u003e48.5%\u003c/p\u003e\n \u003cp\u003e15.2%\u003c/p\u003e\n \u003cp\u003e26.3%\u003c/p\u003e\n \u003cp\u003e7.0%\u003c/p\u003e\n \u003cp\u003e1.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e252\u003c/p\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.4%\u003c/p\u003e\n \u003cp\u003e49.1%\u003c/p\u003e\n \u003cp\u003e15.4%\u003c/p\u003e\n \u003cp\u003e26.7%\u003c/p\u003e\n \u003cp\u003e7.8%\u003c/p\u003e\n \u003cp\u003e0.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.630*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" style=\"width: 598px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003cp\u003ea. In this table, more than 20% of the cells have expected cell counts less than 5. The chi-square results may be invalid.\u003c/p\u003e\n \u003cp\u003eb. In this table, the minimum expected cell count is less than 1. The chi-square results may be invalid.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eRegarding gender distribution, the partial resection group consisted of 69.6% females and 30.4% males, while the total resection group consisted of 71.7% females and 28.3% males. No statistically significant difference was observed between the two groups (P=0.592). In terms of age, the mean age was 47.25 years with a standard deviation of 15.633 in the partial resection group, and 47.3 years with a standard deviation of 15.697 in the total resection group. The age distributions were similar, with no statistically significant difference (U=0.976). Regarding racial distribution, the partial resection group included 81.9% Caucasians, 1.2% African Americans, and 17.0% other races, whereas the total resection group included 77.8% Caucasians, 1.2% African Americans, and 21.1% other races. The racial distributions were balanced, with no statistically significant difference (chi-square value=0.510). Concerning stage distribution, the partial resection group encompassed 43.9% stage I, 50.3% stage III, and 5.8% stage IV cases, while the total resection group encompassed 43.7% stage I, 50.3% stage III, and 6.0% stage IV cases. The stage distributions were consistent, with no statistically significant difference (P=0.995). Regarding T-stage distribution, the partial resection group included 1.2% T0, 48.5% T1, 15.2% T2, 26.3% T3, 7.0% T4, and 1.8% TX cases, while the total resection group included 0.4% T0, 49.1% T1, 15.4% T2, 26.7% T3, 7.8% T4, and 0.6% TX cases. The T-stage distributions were generally similar, although slight differences were noted in the T0 and TX categories (\u003cem\u003eP\u003c/em\u003e=0.630).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Comparison of Surgical Prognosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prognostic efficacy of total thyroidectomy versus partial thyroidectomy was rigorously evaluated through disease-specific survival (DSS) and overall survival (OS) analyses. Table 2 presents the DSS outcomes, which reveal no statistically significant difference between the partial resection cohort (mean DSS: 203.6\u0026plusmn;3.4 months) and the total resection cohort (mean DSS: 209.3\u0026plusmn;1.2 months; P=0.096). Despite a hazard ratio (HR) of 2.007, indicating a trend toward inferior DSS in the partial resection group, this association did not reach statistical significance. The overlapping survival curves in Figure 2 further corroborate the lack of a definitive DSS advantage for either surgical modality, suggesting comparable disease-specific mortality outcomes.\u003c/p\u003e\n\u003cp\u003eIn contrast, Table 3 demonstrates a statistically significant OS benefit favoring total thyroidectomy. The total resection cohort exhibited a mean OS of 198.1\u0026plusmn;2.2 months, markedly surpassing the 186.9\u0026plusmn;5.0 months observed in the partial resection cohort (P=0.037; HR = 1.650). The distinct separation of OS curves in Figure 3 visually underscores this divergence, suggesting that total resection offers systemic survival benefits beyond direct oncological control. Notably, the disparity in OS outcomes may be attributed to reduced recurrence-driven secondary interventions (such as reoperation risks) and optimized postoperative metabolic management (including standardized thyroid hormone supplementation), which collectively reduce non-cancer morbidity and enhance long-term survival in a population with favorable cancer-specific prognosis\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Prognostic Correlations of Survival Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultivariable Cox regression models for DSS and OS are summarized in Table 4. Age was identified as a significant independent prognostic factor for both DSS (HR = 1.136 per year, 95% CI: 1.062\u0026ndash;1.215, P \u0026lt; 0.001) and OS (HR = 1.085 per year, 95% CI: 1.052\u0026ndash;1.119, P \u0026lt; 0.001), with each additional year associated with an increased mortality risk. Total thyroidectomy demonstrated divergent effects: while it showed a non-significant trend toward improved DSS (HR = 0.384, 95% CI: 0.135\u0026ndash;1.089, P = 0.072), it significantly reduced overall mortality risk by 44.1% (OS: HR = 0.559, 95% CI: 0.323\u0026ndash;0.969, P = 0.038). Advanced T-stage exhibited a borderline association with DSS (HR = 1.751, 95% CI: 0.991\u0026ndash;3.092, P = 0.054), but not with OS (HR = 1.247, 95% CI: 0.947\u0026ndash;1.642, P = 0.116), suggesting that tumor invasiveness primarily drives cancer-specific mortality. Variables such as race, gender, and overall stage showed no significant associations with either endpoint (P \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eIn this study, we assessed the prognostic differences between partial and total resection surgeries in patients with stage N1a differentiated thyroid cancer (DTC) using conditionally matched cases from the SEER database. Our results revealed no statistically significant difference in disease-specific survival (DSS) between the two surgical approaches (P\u0026thinsp;=\u0026thinsp;0.072). However, total resection was associated with significantly improved overall survival (OS) compared to partial resection (P\u0026thinsp;=\u0026thinsp;0.038). Furthermore, Cox regression analysis identified age as a common risk factor for both DSS and OS, while the surgical modality emerged as an independent protective factor exclusively for OS (HR\u0026thinsp;=\u0026thinsp;0.559). These findings provide novel, evidence-based insights into the optimal surgical strategy for stage N1a DTC patients and highlight the complexity of prognostic evaluation when considering different survival endpoints.\u003c/p\u003e\u003cp\u003eTotal thyroidectomy (TT) offers the advantage of reducing the risk of residual disease, as it ensures complete thyroid tissue removal. Previous studies have reported lower recurrence rates following TT(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Additionally, TT minimizes the need for subsequent surgeries, which may involve complications such as recurrent laryngeal nerve injury and hypoparathyroidism(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Our data support these findings, demonstrating significantly better OS for TT patients (P\u0026thinsp;=\u0026thinsp;0.037), potentially due to fewer recurrence-driven complications(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, postoperative management following total thyroidectomy (TT), particularly with levothyroxine (LT4) therapy, plays a crucial role in improving survival. Evidence suggests that well-controlled TSH levels following TT significantly reduce cardiovascular risk(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), especially among younger populations(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), thereby contributing to improved long-term survival. This aligns with our observation that TT patients experienced better overall survival (OS), potentially due to optimized metabolic functions and reduced cardiovascular risks. The literature suggests that TT, compared to partial resection, may improve survival in certain high-risk patients, likely due to better TSH control and optimization of metabolic function(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe lack of significant DSS differences between the two surgical approaches may reflect the relatively short follow-up period in this study. Thyroid cancer recurrence can occur more than 10 years after surgery, and our median follow-up duration of 5 years may not have been sufficient to capture long-term disease-specific mortality. The study demonstrated that the cumulative incidence of recurrence in patients with papillary thyroid cancer (PTC) was 18% at 10 years and 26% at 15 years, supporting the need for longer follow-up periods(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Future studies with longer follow-up durations and larger cohorts are necessary to confirm the potential benefits of TT on DSS.\u003c/p\u003e\u003cp\u003eOur analysis also identified age as a key prognostic factor for both DSS and OS, consistent with previous research indicating that age-related declines in immune function and treatment tolerance significantly impact survival outcomes(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Notably, for patients with N1a-stage DTC, total thyroidectomy appears to offer a more substantial benefit in OS, particularly by preventing recurrence-related complications and enhancing the management of comorbidities.\u003c/p\u003e\u003cp\u003eIn terms of clinical implications, the decision between partial and total thyroidectomy should be individualized based on patient-specific factors, including age, comorbidities, and preferences. While TT provides a survival benefit for many patients, partial thyroidectomy may still be appropriate for low-risk patients with adequate postoperative surveillance.\u003c/p\u003e\u003cp\u003eThis study is limited by the retrospective nature of the SEER database and the absence of molecular data, which could further refine prognostic models. Additionally, the predominantly Caucasian patient population may limit the generalizability of the findings. Future prospective studies should incorporate molecular profiling and longer follow-up to provide more comprehensive insights into the long-term effects of surgical approaches on survival outcomes. Furthermore, research into the role of adjuvant therapies, such as radioactive iodine and targeted therapies, is essential to fully understand their impact when combined with different surgical strategies(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study highlights the benefits of total resection surgery in improving overall survival (OS) in patients with stage N1a differentiated thyroid cancer (DTC) through rigorous case-matching and multifactorial analysis, providing valuable evidence to support clinical decision-making. However, to optimize surgical indications within the framework of precision medicine, it is crucial to integrate individual patient characteristics and emerging therapeutic modalities. Moving forward, the individualization of thyroid cancer treatment should be further advanced through multicenter collaboration and molecular profiling, aimed at refining treatment strategies and improving patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent for publication is not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by\u0026nbsp;the Jiangsu Provincial Double-Innovation Doctor Program [Grant number: 2020-30097],\u0026nbsp;and the Suqian Sci\u0026amp;Tech Program (KY202401).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest regarding the publication of this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe source of datasets supporting the conclusions are included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMitchell AL, Gandhi A, Scott-Coombes D, Perros P. Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines. \u003cem\u003eJ Laryngol Otol\u003c/em\u003e (2016) 130:S150\u0026ndash;S160. doi: 10.1017/S0022215116000578\u003c/li\u003e\n \u003cli\u003eBowers JC, Savaliya BP, Raikot SR, Ahmed SH, Shekouhi R, Popp R, Popp K, Sukniam KB, Kowkabany G, Jimenez PB, et al. Survival Outcomes and Disparities in Surgery Refusal for Papillary Thyroid Cancer. \u003cem\u003eAnticancer Res\u003c/em\u003e (2024) 44:5455\u0026ndash;5461. doi: 10.21873/anticanres.17371\u003c/li\u003e\n \u003cli\u003eCallender GG, Carling T, Christison-Lagay E, Udelsman R. Surgery for Thyroid Cancer. \u003cem\u003eEndocrinol Metab Clin North Am\u003c/em\u003e (2014) 43:443\u0026ndash;458. doi: 10.1016/j.ecl.2014.02.011\u003c/li\u003e\n \u003cli\u003eHsiao V, Light TJ, Adil AA, Tao M, Chiu AS, Hitchcock M, Arroyo N, Fernandes-Taylor S, Francis DO. Complication Rates of Total Thyroidectomy vs Hemithyroidectomy for Treatment of Papillary Thyroid Microcarcinoma: A Systematic Review and Meta-analysis. \u003cem\u003eJAMA Otolaryngol\u0026ndash;Head Neck Surg\u003c/em\u003e (2022) 148:531. doi: 10.1001/jamaoto.2022.0621\u003c/li\u003e\n \u003cli\u003eLechner MG, Praw SS, Angell TE. Treatment of Differentiated Thyroid Carcinomas. \u003cem\u003eSurg Pathol Clin\u003c/em\u003e (2019) 12:931\u0026ndash;942. doi: 10.1016/j.path.2019.08.003\u003c/li\u003e\n \u003cli\u003eScheller B, Culi\u0026eacute; D, Poissonnet G, Dassonville O, D\u0026rsquo;Andr\u0026eacute;a G, Bozec A. Recent Advances in the Surgical Management of Thyroid Cancer. \u003cem\u003eCurr Oncol\u003c/em\u003e (2023) 30:4787\u0026ndash;4804. doi: 10.3390/curroncol30050361\u003c/li\u003e\n \u003cli\u003eBayadsi H, Nyl\u0026eacute;n C, Sandstr\u0026ouml;m M, Angelsten J, Sund M, Hennings J. Risk factors for recurrent disease in small papillary thyroid cancers \u0026ndash; a Swedish register-based study. \u003cem\u003eLangenbecks Arch Surg\u003c/em\u003e (2023) 408:162. doi: 10.1007/s00423-023-02905-5\u003c/li\u003e\n \u003cli\u003eGuo Y, Zhang Y, Mao S, Zhang W, Yang F, Wang R, Chen H, Zhang A, Yao X. Risk of subsequent primary cancers in bladder cancer survivors. \u003cem\u003eClin Exp Med\u003c/em\u003e (2024) 24:247. doi: 10.1007/s10238-024-01502-0\u003c/li\u003e\n \u003cli\u003eGuo Y, Zheng Z, Zhang W, Mao S, Yang F, Li W, Yan Y, Yao X. Gender dimorphism in survival of patients with lymph node metastasis of bladder cancer. \u003cem\u003eTher Adv Med Oncol\u003c/em\u003e (2022) 14:17588359221108690. doi: 10.1177/17588359221108690\u003c/li\u003e\n \u003cli\u003eBilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS, Sturgeon C. Extent of Surgery Affects Survival for Papillary Thyroid Cancer. \u003cem\u003eAnn Surg\u003c/em\u003e (2007) 246:375\u0026ndash;384. doi: 10.1097/SLA.0b013e31814697d9\u003c/li\u003e\n \u003cli\u003eZhang C, Li Y, Li J, Chen X. Total thyroidectomy versus lobectomy for papillary thyroid cancer: A systematic review and meta-analysis. \u003cem\u003eMedicine (Baltimore)\u003c/em\u003e (2020) 99:e19073. doi: 10.1097/MD.0000000000019073\u003c/li\u003e\n \u003cli\u003eVassiliou I, Tympa A, Arkadopoulos N, Nikolakopoulos F, Petropoulou T, Smyrniotis V. Total thyroidectomy as the single surgical option for benign and malignant thyroid disease: a surgical challenge. \u003cem\u003eArch Med Sci\u003c/em\u003e (2013) 1:74\u0026ndash;78. doi: 10.5114/aoms.2013.33065\u003c/li\u003e\n \u003cli\u003eRodondi N, Den Elzen WPJ, Bauer DC, Cappola AR, Razvi S, Walsh JP, \u0026Aring;svold BO, Iervasi G, Imaizumi M, Collet T-H, et al. Subclinical Hypothyroidism and the Risk of Coronary Heart Disease and Mortality. \u003cem\u003eJAMA\u003c/em\u003e (2010) 304:1365. doi: 10.1001/jama.2010.1361\u003c/li\u003e\n \u003cli\u003eRazvi S, Shakoor A, Vanderpump M, Weaver JU, Pearce SHS. The Influence of Age on the Relationship between Subclinical Hypothyroidism and Ischemic Heart Disease: A Metaanalysis. \u003cem\u003eJ Clin Endocrinol Metab\u003c/em\u003e (2008) 93:2998\u0026ndash;3007. doi: 10.1210/jc.2008-0167\u003c/li\u003e\n \u003cli\u003eJonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, et al. Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. \u003cem\u003eThyroid\u003c/em\u003e (2014) 24:1670\u0026ndash;1751. doi: 10.1089/thy.2014.0028\u003c/li\u003e\n \u003cli\u003eBi J, Zhang H. A meta-analysis of total thyroidectomy and lobectomy outcomes in papillary thyroid microcarcinoma. \u003cem\u003eMedicine (Baltimore)\u003c/em\u003e (2023) 102:e36647. doi: 10.1097/MD.0000000000036647\u003c/li\u003e\n \u003cli\u003eDurante C, Montesano T, Torlontano M, Attard M, Monzani F, Tumino S, Costante G, Meringolo D, Bruno R, Trulli F, et al. Papillary Thyroid Cancer: Time Course of Recurrences During Postsurgery Surveillance. \u003cem\u003eJ Clin Endocrinol Metab\u003c/em\u003e (2013) 98:636\u0026ndash;642. doi: 10.1210/jc.2012-3401\u003c/li\u003e\n \u003cli\u003eNational Thyroid Cancer Treatment Cooperative Study Registr Group, Sherman SI, Brierley JD, Sperling M, Ain KB, Bigos ST, Cooper DS, Haugen BR, Ho M, Klein I, et al. Prospective multicenter study of thyroid carcinoma treatment: Initial analysis of staging and outcome. \u003cem\u003eCancer\u003c/em\u003e (1998) 83:1012\u0026ndash;1021. doi: 10.1002/(SICI)1097-0142(19980901)83:5\u0026lt;1012::AID-CNCR28\u0026gt;3.0.CO;2-9\u003c/li\u003e\n \u003cli\u003eFoster AD, Sivarapatna A, Gress RE. The Aging Immune System and Its Relationship with Cancer. \u003cem\u003eAging Health\u003c/em\u003e (2011) 7:707\u0026ndash;718. doi: 10.2217/ahe.11.56\u003c/li\u003e\n \u003cli\u003eStewart LA, Kuo JH. Advancements in the treatment of differentiated thyroid cancer. \u003cem\u003eTher Adv Endocrinol Metab\u003c/em\u003e (2021) 12:20420188211000251. doi: 10.1177/20420188211000251\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"differentiated thyroid cancer, N1a, partial thyroidectomy, total thyroidectomy, prognosis","lastPublishedDoi":"10.21203/rs.3.rs-7209352/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7209352/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo compare the prognosis of patients with differentiated thyroid cancer (DTC) in N1a stage following partial versus total resection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study included patients aged 15 to 79 years diagnosed with N1a stage DTC, as per the 6th edition of the American Joint Committee on Cancer (AJCC) staging system, from 2004 to 2015. Exclusion criteria were: unknown ethnicity, M1 stage (6th edition AJCC), UNK stage group, pathological types such as anaplastic or medullary carcinoma, and indeterminate surgical extent. Cases were matched at a 3:1 ratio (total to partial thyroidectomy) based on a standard deviation difference in age of ≤0.01, an age discrepancy of ≤3 years, and identical T and overall stages. Survival analysis was conducted using the Kaplan-Meier method, and survival curves were generated. The log-rank and Breslow tests compared outcomes between groups. Cox proportional hazards regression model assessed the independent predictive capacity of variables, with a significance threshold of P\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eIn balanced matched cases, the type of surgical intervention in patients with DTC in N1a stage did not significantly influence disease-specific survival (DSS; P=0.072). However, a significant effect on overall survival (OS) was noted (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05).\u003c/p\u003e","manuscriptTitle":"Prognostic Impact of Surgical Extent in N1a-Stage Differentiated Thyroid Cancer: SEER Matched Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 06:12:34","doi":"10.21203/rs.3.rs-7209352/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f3a212cb-4392-4acf-8810-607e84d4391d","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-24T13:39:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 06:12:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7209352","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7209352","identity":"rs-7209352","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}