Abstract
The tall cell variant of papillary thyroid carcinoma (TCV-PTC) is an aggressive subtype with a poorer prognosis. Controversy persists regarding the surgical strategy for TCV-PTC. Using the SEER database (2005–2017), we analyzed 1,463 patients with pathologically confirmed TCV-PTC who underwent either total thyroidectomy (TT) (n = 1,369) or lobectomy (n = 94). Propensity score matching (PSM) was used to address confounding biases. The primary endpoint was cancer-specific survival (CSS), assessed using Kaplan-Meier analysis and Cox regression. After PSM (n = 376), TT demonstrated superior CSS compared to lobectomy (p = 0.019). The 5-year and 10-year CSS for TT were 97.8% and 95.0% versus 90.7% and 89.1% for lobectomy in the matched cohort. This survival benefit of TT persisted regardless of radioiodine therapy (RAI) (p < 0.05). Multivariable analysis identified lobectomy, tumor size > 40 mm, extrathyroidal extension, and lymph node metastasis as independent risk factors for reduced CSS. Total thyroidectomy is associated with improved CSS compared to lobectomy in TCV-PTC, independent of RAI. Greater caution should be considered in selecting lobectomy for TCV patients, especially for patients with tumors > 40 mm, lymph node metastasis, or extrathyroidal extension. Completion thyroidectomy may be beneficial for patients diagnosed with TCV-PTC after lobectomy.
Data availability
The data that support the findings of this study are openly available in software package SEER*Stat 8.3.6 (https://seer.cancer.gov/seerstat/).
References
Pizzato, M. et al. The epidemiological landscape of thyroid cancer worldwide: GLOBOCAN estimates for incidence and mortality rates in 2020. Lancet Diabetes Endocrinol. 10 (4), 264–272 (2022).
Sung, H. et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 71 (3), 209–249 (2021).
Baloch, Z. W. et al. Overview of the 2022 WHO classification of thyroid neoplasms. Endocr. Pathol. 33 (1), 27–63 (2022).
Turchini, J. et al. A critical assessment of diagnostic criteria for the tall cell subtype of papillary thyroid Carcinoma-How much? How tall? And when is it relevant? Endocr. Pathol. 34 (4), 461–470 (2023).
Dettmer, M. S. et al. Tall cell papillary thyroid carcinoma: new diagnostic criteria and mutations in BRAF and TERT. Endocr. Relat. Cancer. 22 (3), 419–429 (2015).
Hawk, W. A. & Hazard, J. B. The many appearances of papillary carcinoma of the thyroid. Cleve Clin. Q. 43 (4), 207–215 (1976).
Haugen, B. R. et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26 (1), 1–133 (2016).
Ringel, M. D. et al. 2025 American thyroid association management guidelines for adult patients with differentiated thyroid cancer. Thyroid 35 (8), 841–985 (2025).
Dai, P., Zhao, W., Zheng, X., Luo, H. & Wang, X. Effect of radioactive iodine therapy on cancer-Specific survival of papillary thyroid cancer tall cell variant. J. Clin. Endocrinol. Metab. 109 (3), e1260–e6 (2024).
Hsiao, V. et al. Complication rates of total thyroidectomy vs hemithyroidectomy for treatment of papillary thyroid microcarcinoma: A systematic review and Meta-analysis. JAMA Otolaryngol. Head Neck Surg. 148 (6), 531–539 (2022).
Kwon, H. et al. A comparison of lobectomy and total thyroidectomy in patients with papillary thyroid microcarcinoma: a retrospective individual risk factor-matched cohort study. Eur. J. Endocrinol. 176 (4), 371–378 (2017).
Woods, R. S. R. et al. Surgical management of T1/T2 node-negative papillary thyroid cancer with tall cell histology: is lobectomy enough? Surgery 173 (1), 246–251 (2023).
Axelsson, T. A., Hrafnkelsson, J., Olafsdottir, E. J. & Jonasson, J. G. Tall cell variant of papillary thyroid carcinoma: a population-based study in Iceland. Thyroid 25 (2), 216–220 (2015).
Wu, S. S. et al. Risk factors associated with recurrence and death in patients with tall cell papillary thyroid cancer: A Single-Institution cohort study with predictive nomogram. JAMA Otolaryngol. Head Neck Surg. 149 (1), 79–86 (2023).
Moon, S. et al. Effects of coexistent BRAF(V600E) and TERT promoter mutations on poor clinical outcomes in papillary thyroid cancer: A Meta-Analysis. Thyroid 27 (5), 651–660 (2017).
Xing, M. et al. BRAF V600E and TERT promoter mutations cooperatively identify the most aggressive papillary thyroid cancer with highest recurrence. J. Clin. Oncol. 32 (25), 2718–2726 (2014).
Kim, K., Jung, C. K., Lim, D. J., Bae, J. S. & Kim, J. S. Comparison of the clinicopathological features and oncologic outcomes of the classic papillary thyroid carcinoma with tall cell features and tall cell variant. Gland Surg. 11 (1), 56–66 (2022).
Liu, Z. et al. A comparison of the clinicopathological features and prognoses of the classical and the tall cell variant of papillary thyroid cancer: a meta-analysis. Oncotarget 8 (4), 6222–6232 (2017).
Morris, L. G., Shaha, A. R., Tuttle, R. M., Sikora, A. G. & Ganly, I. Tall-cell variant of papillary thyroid carcinoma: a matched-pair analysis of survival. Thyroid 20 (2), 153–158 (2010).
Chen, M. L., Xu, D., Yan, X. Q. & Xie, B. J. Delphian lymph node metastasis predicts occult contralateral carcinoma for unilateral papillary thyroid carcinoma patients with contralateral benign nodules. Asian J. Surg. 46 (1), 156–159 (2023).
Chen, X. et al. Predictive factors of contralateral occult carcinoma in patients with papillary thyroid carcinoma: a retrospective study. Gland Surg. 9 (4), 872–878 (2020).
Zhang, F. et al. Risk factors for contralateral occult carcinoma in patients with unilateral papillary thyroid carcinoma: A retrospective study and Meta-Analysis. Front. Endocrinol. (Lausanne). 12, 675643 (2021).
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Hao Zhang was responsible for the conceptualization and proofreading of the manuscript. Yubo Sun and Yuxin Jia contributed to the data analysis and the drafting of the initial manuscript. All authors have read and approved the final manuscript.
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Sun, Y., Jia, Y. & Zhang, H. Comparison of cancer-specific survival between total thyroidectomy and lobectomy in tall cell variant of papillary thyroid carcinoma. Sci Rep (2026). https://doi.org/10.1038/s41598-026-40070-z
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DOI: https://doi.org/10.1038/s41598-026-40070-z
