Background/Objectives: Whether thyroidectomy confers a long-term survival advantage over non-surgical management in real-world practice remains uncertain. We primarily evaluated the association between surgery and all-cause mortality in thyroid cancer; specialty-stratified outcomes were prespecified as secondary, exploratory analyses. Methods: Using the TriNetX US Collaborative Network (2008–2024), we identified adults with thyroid cancer and created 1:1 propensity score-matched cohorts of patients who did or did not undergo thyroidectomy, balancing demographics, comorbidities, medications, and laboratory variables. Overall survival was assessed with Kaplan–Meier curves and Cox proportional hazard models. Among the surgical patients, we performed exploratory analyses stratified by operating specialty (otolaryngology–head and neck surgery (reference) vs. general/endocrine surgery and other/unknown, reported descriptively). Results: After matching, 49,219 patients were included per cohort. Thyroidectomy was associated with lower long-term mortality versus non-surgical care (adjusted HR 0.685, 95% CI 0.652–0.721). Among the surgical patients, secondary, exploratory specialty-stratified analyses suggested differences: compared with otolaryngology–head and neck surgery (ENT–HNS; reference), general/endocrine surgery (GS/ES) had a lower adjusted hazard of death (aHR 0.561, 95% CI 0.481–0.654), whereas other/unknown specialties had a higher adjusted hazard (aHR 1.583, 95% CI 1.302–1.924). These patterns are hypothesis-generating and may reflect residual confounding, including the tumor stage and histology, referral pathways, and surgeon or center experience. Conclusions: In a large, propensity-matched real-world cohort, surgery was linked to improved long-term survival regarding thyroid cancer. Observed specialty-related variation should be interpreted cautiously, and prospective studies incorporating tumor-level variables and provider/center characteristics are needed. Emphasis should remain on timely surgery within multidisciplinary care pathways.
背景/目的：在真实世界实践中，甲状腺切除术是否比非手术治疗具有长期生存优势仍不确定。本研究主要评估了甲状腺癌患者手术与全因死亡率之间的关联；按手术专科分层的结果被预设为次要的探索性分析。方法：利用TriNetX美国协作网络（2008–2024年），我们识别出成年甲状腺癌患者，并创建了1:1倾向评分匹配队列，比较接受与未接受甲状腺切除术的患者，平衡了人口统计学特征、合并症、用药情况和实验室变量。通过Kaplan–Meier曲线和Cox比例风险模型评估总生存期。在手术患者中，我们进行了按手术专科分层的探索性分析（以耳鼻咽喉头颈外科为参照，对比普通/内分泌外科及其他/未知专科，结果以描述性方式报告）。结果：匹配后，每个队列纳入49,219名患者。与非手术治疗相比，甲状腺切除术与较低的长期死亡率相关（调整后HR 0.685，95% CI 0.652–0.721）。在手术患者中，次要的探索性专科分层分析提示存在差异：与耳鼻咽喉头颈外科（参照组）相比，普通/内分泌外科的调整后死亡风险较低（aHR 0.561，95% CI 0.481–0.654），而其他/未知专科的调整后死亡风险较高（aHR 1.583，95% CI 1.302–1.924）。这些模式仅为生成假设，可能反映了残留混杂因素，包括肿瘤分期与组织学类型、转诊路径以及外科医生或医疗中心的经验等。结论：在一个大型倾向匹配的真实世界队列中，手术与甲状腺癌患者长期生存改善相关。观察到的专科相关差异应谨慎解读，未来需要纳入肿瘤层面变量及医疗服务提供者/中心特征的前瞻性研究。重点仍应放在多学科诊疗路径中及时进行手术。
肿瘤(癌症)患者之家