{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:39:04Z","timestamp":1792809544623,"version":"4.5.0"},"reference-count":11,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Observational studies report an overall\u2010survival advantage for postoperative radioactive iodine (RAI) in lymph node\u2013positive papillary thyroid carcinoma (PTC), but such estimates are vulnerable to confounding by indication and to bias from immortal time and the healthy\u2010user effect. We assessed the credibility of this apparent benefit rather than RAI efficacy itself.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using SEER (2010\u20132015), we assembled a cohort of N1b, M0, totally thyroidectomized PTC patients and applied a 3\u2010month landmark analysis (sensitivity analyses at 1 and 6\u2009months) with stabilized inverse\u2010probability\u2010of\u2010treatment weighting. We estimated RAI effects on overall survival, cancer\u2010specific survival, and relative survival, and on a negative\u2010control outcome\u2014non\u2013thyroid\u2010cancer death\u2014that RAI cannot plausibly affect. Residual confounding was quantified with E\u2010values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 4275 patients, RAI showed an apparent survival benefit in direction across all three endpoints. However, the negative\u2010control outcome likewise showed an apparent benefit (IPTW hazard ratio 0.713, 95% CI 0.562\u20130.906), indicating residual confounding not removed by weighting. The apparent survival benefits therefore could not be distinguished from unmeasured confounding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In registry data lacking key confounders, a negative control identifies the apparent RAI survival benefit as a candidate artifact of unmeasured confounding. The findings neither support nor refute RAI efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.72320","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T10:25:06Z","timestamp":1792664706000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Apparent Survival Benefit of Postoperative Radioactive Iodine in Lymph Node\u2013Positive Papillary Thyroid Carcinoma: A Negative\u2010Control Analysis for Unmeasured Confounding"],"prefix":"10.1002","volume":"15","author":[{"given":"Tengfei","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Head and Neck Thyroid Surgery Xingtai People's Hospital of Hebei Medical University  Xingtai Hebei Province P. R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junli","family":"Qiao","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Thyroid Surgery Xingtai People's Hospital of Hebei Medical University  Xingtai Hebei Province P. R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengxuan","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Thyroid Surgery Xingtai People's Hospital of Hebei Medical University  Xingtai Hebei Province P. R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3524-6823","authenticated-orcid":false,"given":"Qiang","family":"Guo","sequence":"additional","affiliation":[{"name":"Division of Pancreatic Surgery, Department of General Surgery West China Hospital, Sichuan University  Chengdu Sichuan P. R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology \u2013 Head and Neck Surgery The Fourth Hospital of Hebei Medical University  Shijiazhuang Hebei Province P. R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2111953"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(25)00629-4"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1551075"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwm070"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwm324"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2017.0102"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181d61eeb"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwv254"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v045.i03"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2607"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1541-0420.2011.01640.x"}],"container-title":["Cancer Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.72320","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cam4.72320","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.72320","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:07:54Z","timestamp":1792807674000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.72320"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":11,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/cam4.72320"],"URL":"https:\/\/doi.org\/10.1002\/cam4.72320","archive":["Portico"],"relation":{},"ISSN":["2045-7634","2045-7634"],"issn-type":[{"value":"2045-7634","type":"print"},{"value":"2045-7634","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-07-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e72320"}}