To operate or not to operate: Clinical and sociodemographic determinants of provider advised non-surgical management for thyroid cancer

Background Surgery is the standard treatment for well-differentiated thyroid cancer (WDTC). We assessed clinical characteristics and outcomes in WDTC patients advised against surgery.Methods The National Cancer Database was queried for WDTC patients between 2004 and 2017 who underwent surgery or non-surgical management. Multivariate logistic regression and Kaplan-Meier analyses were performed.Results Predictors of provider recommended nonoperative management of WDTC included age ≥ 55, male sex, diagnosis at academic centers, and non-private insurance. Charlson-Deyo score of ≥ 2 and clinically advanced disease were associated with No Surgery Recommendation. Mean OS was 48 versus 191 months for non-surgical and surgical patients, respectively. In a subgroup of young, healthy patients with low disease burden, those who were recommended nonoperative management demonstrated significantly worse overall survival (median 56.7 months) compared to those who underwent resection.Conclusions The recommendation against surgery for WDTC is associated with worse overall survival, even in patients who are optimal surgical candidates.