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Parvathareddy SK, Siraj AK, Annaiyappanaidu P, Ahmed SO, Al-Sobhi SS, Al-Dayel F, Al-Kuraya KS. Recurrent Middle Eastern Differentiated Thyroid Carcinoma Has Worse Outcomes Than Persistent Disease. J Clin Med 2024; 13:1877. [PMID: 38610642 PMCID: PMC11012810 DOI: 10.3390/jcm13071877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Despite the excellent prognosis of differentiated thyroid carcinoma (DTC), recurrent and persistent disease remain major challenges. Emerging studies to differentiate between recurrent and persistent disease are controversial, with studies from the Middle East lacking. Methods: We retrospectively analyzed 1691 patients who underwent surgery ± I131 treatment for DTC, with a median age of 38.7 years and median follow-up of 95.3 months. Results: We found a similar prevalence rate for persistent and recurrent disease (17.7% vs. 17.9%) in Middle Eastern DTC patients. Relative to patients with persistent disease, patients with recurrent disease were significantly older (median age: 36.1 vs. 45.8 years; p < 0.0001) and were more likely to have ATA high-risk tumors (61.5% vs. 75.2%; p = 0.0003). On multivariate logistic regression analysis, both T and N status were independent predictors for recurrent as well as structural persistent disease. However, older age, bilaterality and extrathyroidal extension were independent predictors of recurrent disease alone. In addition, patients with recurrent disease had significantly worse cancer-specific survival (p < 0.0001), which remained significant in multivariate analysis. Conclusions: Although persistent and recurrent disease in Middle Eastern DTC have similar frequencies, recurrent disease has worse outcomes compared to persistent disease. Hence, differentiating recurrence from persistence has great potential clinical relevance for therapeutic and follow-up approaches, contributing to improving the outcomes of DTC patients of Middle Eastern ethnicity.
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Affiliation(s)
- Sandeep Kumar Parvathareddy
- Human Cancer Genomic Research, Research Centre King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (S.K.P.); (A.K.S.); (P.A.); (S.O.A.)
| | - Abdul K. Siraj
- Human Cancer Genomic Research, Research Centre King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (S.K.P.); (A.K.S.); (P.A.); (S.O.A.)
| | - Padmanaban Annaiyappanaidu
- Human Cancer Genomic Research, Research Centre King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (S.K.P.); (A.K.S.); (P.A.); (S.O.A.)
| | - Saeeda O. Ahmed
- Human Cancer Genomic Research, Research Centre King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (S.K.P.); (A.K.S.); (P.A.); (S.O.A.)
| | - Saif S. Al-Sobhi
- Department of Surgery, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia;
| | - Fouad Al-Dayel
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia;
| | - Khawla S. Al-Kuraya
- Human Cancer Genomic Research, Research Centre King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (S.K.P.); (A.K.S.); (P.A.); (S.O.A.)
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Gillis A, Chen H, Wang TS, Dream S. Racial and Ethnic Disparities in the Diagnosis and Treatment of Thyroid Disease. J Clin Endocrinol Metab 2024; 109:e1336-e1344. [PMID: 37647887 PMCID: PMC10940267 DOI: 10.1210/clinem/dgad519] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/01/2023]
Abstract
CONTEXT There are differences in diagnosis, treatment, and outcomes for thyroid between racial and ethnic groups that contribute to disparities. Identifying these differences and their causes are the key to understanding and reducing disparities in presentation and outcomes in endocrine disorders. EVIDENCE ACQUISITION The present study reviews original studies identifying and exploring differences between benign and malignant thyroid diseases. A PubMed, Web of Science, and Scopus search was conducted for English-language studies using the terms "thyroid," "thyroid disease," "thyroid cancer," "race," "ethnicity," and "disparities" from inception to December 31, 2022. EVIDENCE SYNTHESIS Many racial and ethnic disparities in the diagnosis, presentation, treatment, and outcomes of thyroid disease were found. Non-White patients are more likely to have a later time to referral, to present with more advanced disease, to have more aggressive forms of thyroid cancer, and are less likely to receive the appropriate treatment than White patients. Overall and disease-specific survival rates are lower in Black and Hispanic populations when compared to White patients. CONCLUSIONS Extensive disparities exist in thyroid disease diagnosis, treatment, and outcomes that may have been overlooked. Further work is needed to identify the causes of these disparities to begin to work toward equity in the care of thyroid disease.
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Affiliation(s)
- Andrea Gillis
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53266, USA
| | - Sophie Dream
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53266, USA
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Hurst ZA, Liyanarachchi S, Brock P, He H, Nabhan F, Veloski C, Toland AE, Ringel MD, Jhiang SM. Presumed Pathogenic Germ Line and Somatic Variants in African American Thyroid Cancer. Thyroid 2024; 34:378-387. [PMID: 38062767 PMCID: PMC10951570 DOI: 10.1089/thy.2023.0487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background: African American (AA) thyroid cancer patients have worse prognoses than European Americans (EA), which has been attributed to both health care disparities and possible genetic differences. We investigated the impact of both germ line and somatic variants on clinical outcome in a cohort of AA nonmedullary thyroid cancer (NMTC) patients who had received therapeutic intervention from cancer centers. Methods: Whole-exome sequencing was performed on DNA from available blood/normal tissues (N = 37) and paired tumor samples (N = 32) collected from 37 and 29 AA NMTC patients, respectively. Variants with Combined Annotation Depletion Dependent (CADD) score of ≥20 and VarSome Clinical classification of likely pathogenic or pathogenic were classified as presumed pathogenic germ line or somatic variants (PPGVs/PPSVs). PPGVs/PPSVs in cancer-related genes and PPGVs in cardiovascular risk genes were further investigated, and PPGVs/PPSVs associated with African (AFR) ancestry were identified. Results: Among 17 PPGVs identified in 16 cancer predisposition or known cancer-related genes, only WRN was previously known to associate with NMTC predisposition. Among PPSVs, BRAFV600E was most the prevalent and detected in 12 of the 29 (41%) tumors. Examining PPGVs/PPSVs among three patients who died from NMTC, one patient who died from papillary thyroid carcinoma/anaplastic thyroid carcinoma (PTC/ATC) led us to speculate that the PPGV ERCC4R799W may have increased the risk of PPSV TP53R273H acquisition. Among PPGVs identified in 18 cardiovascular risk genes, PPGVs in SC5NA, GYG1, CBS, CFTR, and SI are known to have causal and pathogenic implications in cardiovascular disease. Conclusion: In this cohort, most AA-NMTC patients exhibit favorable outcomes after therapeutic intervention given at cancer centers, suggesting that health care disparity is the major contributor for worse prognoses among AA-NMTC patients. Nevertheless, the clinical impact of PPGVs that might facilitate the acquisition of TP53 tumor mutations, and/or PPGVs that predispose individuals to adverse cardiovascular events, which could be exacerbated by therapy-induced cardiotoxicity, needs to be further explored. Integrated analysis of PPGV/PPSV profiles among NMTC patients with different stages of disease may help to identify NMTC patients who require close monitoring or proactive intervention.
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Affiliation(s)
- Zachary A. Hurst
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sandya Liyanarachchi
- Department of Molecular Medicine and Therapeutics, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Pamela Brock
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Huiling He
- Department of Molecular Medicine and Therapeutics, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Fadi Nabhan
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Colleen Veloski
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Amanda E. Toland
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
- Department of Cancer Biology and Genetics, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Matthew D. Ringel
- Department of Molecular Medicine and Therapeutics, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Sissy M. Jhiang
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Ginzberg SP, Soegaard Ballester JM, Wirtalla CJ, Morales KH, Pryma DA, Mandel SJ, Kelz RR, Wachtel H. Racial and Ethnic Disparities in Appropriate Thyroid Cancer Treatment, Before and After the Release of the 2015 American Thyroid Association Guidelines. Ann Surg Oncol 2023; 30:2928-2937. [PMID: 36749501 DOI: 10.1245/s10434-023-13158-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/12/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND The 2015 American Thyroid Association (ATA) guidelines reduced the recommended extent of therapy for low-risk thyroid cancers. Little is known about the impact of these changes on overall treatment patterns and on previously described racial/ethnic disparities in guideline-concordant care. This study aimed to assess trends in thyroid cancer care before and after release of the 2015 guidelines, with particular attention to racial/ethnic disparities. METHODS Patients with well-differentiated thyroid cancer were identified from the National Cancer Database (2010-2018). An interrupted time series design was used to assess trends in treatment before and after the 2015 guidelines. Appropriateness of surgical and radioactive iodine (RAI) treatment was determined based on the ATA guidelines, and the likelihood of receiving guideline-concordant treatment was compared between racial/ethnic groups. RESULTS The study identified 309,367 patients (White 74%, Black 8%, Hispanic 9%, Asian 6%). Between 2010 and 2015, the adjusted probability of appropriate surgery was lower for Black (- 2.1%; p < 0.001), Hispanic (- 1.0%; p < 0.001), and Asian (- 2.1%; p < 0.001) patients than for White patients. After 2015, only Hispanic patients had a lower probability of undergoing appropriate surgical therapy (- 2.6%; p = 0.040). Similarly, between 2010 and 2015, the adjusted probability of receiving appropriate RAI therapy was lower for the Hispanic (- 3.6%; p < 0.001) and Asian (- 2.4%; p < 0.001) patients than for White patients. After 2015, the probability of appropriate RAI therapy did not differ between groups. CONCLUSIONS Between 2010 and 2015, patients from racial/ethnic minority backgrounds were less likely than White patients to receive appropriate surgical and RAI therapy for thyroid cancer. After the 2015 guidelines, racial/ethnic disparities in treatment improved.
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Affiliation(s)
- Sara P Ginzberg
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | | | | | - Knashawn H Morales
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel A Pryma
- Division of Nuclear Medicine, Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Susan J Mandel
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Rachel R Kelz
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Heather Wachtel
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
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Rano E, Lin L, Molinie V, Sulpicy C, Dorival MJ, Drak Alsibai K, Nacher M, Drame M, Sabbah N. Epidemiological, Clinical, Ultrasonographic and Cytological Characteristics of Thyroid Nodules in an Afro-Caribbean Population: A Series of 420 Patients. Cancers (Basel) 2022; 14:cancers14102365. [PMID: 35625970 PMCID: PMC9139893 DOI: 10.3390/cancers14102365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary This study describes the epidemiological, clinical and ultrasound characteristics of malignancy in thyroid nodules and evaluates the value of cytology in the diagnosis of malignancy in an Afro-Caribbean population. Our results revealed that none of the standard ultrasound criteria of malignancy were significantly predictive of cancer, but hypoechogenicity and central vascularity were frequently found in malignant nodules. These results could increase awareness and guide practitioners in their diagnostic approach and management of thyroid nodules in Afro-Caribbean populations. Bethesda system-based cytology revealed low sensitivity in analyzing the risk of malignancy in this population. The high prevalence of papillary microcarcinomas may explain the inconclusive ultrasound and cytological results. Abstract The incidence of thyroid cancer is increasing worldwide. The aim of this study is to describe the epidemiological, clinical and ultrasound characteristics of malignancy in thyroid nodules and to evaluate the predictive value of the Bethesda system for thyroid cytology in the diagnosis of malignancy in an Afro-Caribbean population. We conducted a retrospective study in Martinique involving 420 patients with a diagnosis of thyroid nodules between 2011 and 2014. Of the 192/420 (45.7%) patients operated on for thyroid nodules, 9% had thyroid cancer. All patients with thyroid cancer were obese women with a mean age of 50 years. The final histological examination revealed papillary microcarcinomas in 61% of cases and papillary carcinomas in 39% of cases. Thyroid cytology alone had a low sensitivity (22.2%) and positive predictive value (15.4%) for the diagnosis of malignancy, with a good specificity (91.1%) and negative predictive value (94.2%). None of the standard ultrasound criteria of malignancy were significantly predictive of cancer, but hypoechogenicity and central vascularity were frequently found in malignant nodules. These epidemiological, clinical and ultrasound results could increase awareness and guide practitioners in their diagnostic approach and management of thyroid nodules in an Afro-Caribbean population. Bethesda system-based cytology revealed lower sensitivity in analyzing the risk of malignancy in this population. The high prevalence of papillary microcarcinomas may explain the inconclusive ultrasound and cytological results.
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Affiliation(s)
- Elodie Rano
- Department of Endocrinology and Metabolic Diseases, University Hospital Centre Louis Domergues, F-97220 La Trinité, France; (E.R.); (L.L.)
| | - Lucien Lin
- Department of Endocrinology and Metabolic Diseases, University Hospital Centre Louis Domergues, F-97220 La Trinité, France; (E.R.); (L.L.)
| | - Vincent Molinie
- Department of Pathology, University Hospital Centre Pierre Zobda Quitman, F-97261 Fort-de-France, France;
| | | | | | - Kinan Drak Alsibai
- Centre of Biological Resources (CRB Amazonie), Cayenne Hospital Centre, F-97306 Cayenne, French Guiana;
- Clinical Investigation Center Antilles-French Guiana (CIC, INSERM 1424) Cayenne Hospital Centre Andrée Rosemon, F-97306 Cayenne, French Guiana;
| | - Mathieu Nacher
- Clinical Investigation Center Antilles-French Guiana (CIC, INSERM 1424) Cayenne Hospital Centre Andrée Rosemon, F-97306 Cayenne, French Guiana;
| | - Moustafa Drame
- Department of Medical Information, University Hospital Centre Pierre Zobda Quitman, F-97261 Fort-de-France, France;
| | - Nadia Sabbah
- Clinical Investigation Center Antilles-French Guiana (CIC, INSERM 1424) Cayenne Hospital Centre Andrée Rosemon, F-97306 Cayenne, French Guiana;
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Centre Andrée Rosemon, F-97306 Cayenne, French Guiana
- Correspondence: ; Tel.: +(594)-0594395276
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6
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Clinical Factors Predictive of Lymph Node Metastasis in Thyroid Cancer Patients: A Multivariate Analysis. J Am Coll Surg 2022; 234:691-700. [PMID: 35290290 DOI: 10.1097/xcs.0000000000000107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Early-stage thyroid cancers have excellent survival. However, lymph node metastases (LNM) confer a worse prognosis and are not always known preoperatively. Therefore, investigation on the clinical and histological factors predictive of LNM in thyroid cancers was conducted to tailor the extent of surgery and radioactive iodine therapy. STUDY DESIGN Multivariate logistic regressions were performed based on retrospective data from thyroid cancer patients seen between 2013 and 2020 at a single institution. RESULTS Among 913 patients, mean age was 49.4 years, 76.5% were female, 58.3% were White, 21.2% were Black, and 27.9% had LNM. In the multivariate analyses in which the outcome was LNM, White (odds ratio [OR] 1.74, 95% CI 0.98 to 3.15, p = 0.064) and Hispanic patients (OR 2.36, 95% CI 0.97 to 5.77, p = 0.059) trended toward higher risk of LNM compared to Black patients, whereas age (OR 0.98, 95% CI 0.97 to 1.00, p = 0.008) showed protective effect. Tumor size (OR 1.04, 95% CI 1.01 to 1.07, p = 0.007), extrathyroidal extension (OR 2.46, 95% CI 1.53 to 3.97, p < 0.001), lymphovascular invasion (OR 6.30, 95% CI 3.68 to 11.14, p < 0.001), and multifocality (OR 1.47, 95% CI 1.01 to 2.12, p = 0.042) were associated with higher risk of LNM. In another model with outcome as >5 LNM, tumor size (OR 1.07, 95% CI 1.03 to 1.11, p = 0.001), age (OR 0.95, 95% CI 0.93 to 0.97, p < 0.001), extrathyroidal extension (OR 3.20, 95% CI 1.83 to 5.61, p < 0.001), and lymphovascular invasion (OR 6.82, 95% CI 3.87 to 12.17, p < 0.001) remained significant predictors. CONCLUSION Our analyses demonstrated and confirmed that age, tumor size, extrathyroidal extension, and lymphovascular invasion are independent predictors of significant LNM, thereby conferring higher risk of recurrence. Risk of LNM based on these patient characteristics should be considered when planning an operative approach.
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Zheng H, Lai V, Lu J, Kang JK, Felger EA, Carroll NM, Burman KD, Wartofsky L, Rosen JE. Comparing the rate and extent of malignancy in surgically excised thyroid nodules across race and ethnicity. Am J Surg 2021; 223:617-623. [PMID: 34600740 DOI: 10.1016/j.amjsurg.2021.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/23/2021] [Accepted: 09/22/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Few studies have compared the features of thyroid cancer among races and ethnicities. We hypothesized that race and ethnicity may influence the frequency and features of thyroid malignancy in thyroid nodules. METHOD This was a retrospective chart review of patients between 2013 and 2020 who underwent thyroidectomy. RESULTS In the analysis of 2737 patients, thyroid cancer was less prevalent among Blacks (24.0% vs Whites 52.1%, Hispanics 58.7%, Asians 71.7%, and Others 57.9%, p < 0.001). Thyroid cancer in Blacks was less likely to have extrathyroidal extension (9.7% vs Whites 18.6%, Hispanics 25.8%, Asians 18.2%, and Others 17.8%, p = 0.01), overall nodal involvement (12.4% vs Whites 31.1%, Hispanics 37.5%, Asians 36.3%, and Others 30.1%, p < 0.01), and lateral neck metastasis (4.4% vs Whites 10.8%, Hispanics 6.3%, Asians 13.2%, and Others 9.6%, p = 0.02). CONCLUSIONS Race and ethnicity may play important roles in the risk of malignancy as well as in the extent of thyroid cancer.
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Affiliation(s)
- Hui Zheng
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA; MedStar-Georgetown University Hospital, Department of Surgery, 3800 Reservoir Rd NW, Washington, DC, 20007, USA.
| | - Victoria Lai
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA
| | - Jana Lu
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Jin K Kang
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA; MedStar-Georgetown University Hospital, Department of Surgery, 3800 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Erin A Felger
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA
| | - Nancy M Carroll
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA
| | - Kenneth D Burman
- MedStar-Washington Hospital Center, Section of Endocrinology, 110 Irving St NW, Washington DC, 20010, USA
| | - Leonard Wartofsky
- MedStar Health Research Institute, Thyroid Cancer Unit, 100 Irving St NW, Washington, DC, 20010, USA
| | - Jennifer E Rosen
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA
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8
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Crepeau PK, Kulkarni K, Martucci J, Lai V. Comparing surgical thoroughness and recurrence in thyroid cancer patients across race/ethnicity. Surgery 2021; 170:1099-1104. [PMID: 34127303 DOI: 10.1016/j.surg.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/05/2021] [Accepted: 05/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND For patients with differentiated thyroid cancer who will receive postoperative radioactive iodine, thyroid remnant uptake can be calculated and may point to the thoroughness of the surgical resection. In the United States, outcome disparities exist among ethnic/racial minorities with differentiated thyroid cancer. Data about surgical thoroughness and recurrence rates across races/ethnicities do not exist. This study compared the amount of thyroid remnant uptake and cancer recurrence rates across race/ethnicity. METHODS This was a retrospective analysis of adult patients with differentiated thyroid cancer who had postoperative radioactive iodine in 2017 and 2018 and were followed to 2020. We collected thyroid bed remnant uptake from postoperative radioactive iodine scans and analyzed it as a ratio of percent of uptake to dose of radioactive iodine received to control for varying radioactive iodine doses. Thyroid remnant, uptake to dose of radioactive iodine received, and recurrence were evaluated across race/ethnicity. RESULTS Of 218 patients: 61% were White, 21% Black, 11% Asian, and 7% Hispanic; 72% were female. Seventy-one percent of patients had their surgery done by a high-volume surgeon, although volume data were not available for all. In White, Black, Asian, and Hispanic patients, median uptake was 0.68%, 0.44%, 1.5%, and 0.8%, respectively (P = .13). We did not observe differences in median uptake to dose of radioactive iodine received across groups (P = .41). Recurrence rate was 17.0% among White patients, 16.7% among Black patients, 17.6% among Asian patients, and 16.7% among Hispanic patients (P = 1.00). CONCLUSION We did not observe differences across race/ethnicity in surgical thoroughness or rate of recurrence. These findings suggest that disparities may be mitigated when ethnic/racial minorities have similar access to quality surgical care.
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Affiliation(s)
- Philip K Crepeau
- Department of Surgery, MedStar Georgetown University/Washington Hospital Center, Washington, DC
| | - Kanchan Kulkarni
- Department of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | | | - Victoria Lai
- Department of Surgery, MedStar Georgetown University/Washington Hospital Center, Washington, DC.
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Patel S, Pappoppula L, Guddati AK, Annamaraju P. Analysis of Race and Gender Disparities in Incidence-Based Mortality in Patients Diagnosed with Thyroid Cancer from 2000 to 2016. Int J Gen Med 2020; 13:1589-1594. [PMID: 33364821 PMCID: PMC7751731 DOI: 10.2147/ijgm.s280986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/01/2020] [Indexed: 01/01/2023] Open
Abstract
Background Well-differentiated thyroid cancer has better outcomes compared to undifferentiated/anaplastic thyroid cancer. The incidence of well-differentiated thyroid cancer is known to be more in women whereas it is approximately the same in both genders for anaplastic thyroid cancer. The variability of incidence-based mortality across gender in the context of race has not been studied. This study analyzes the rates of incidence-based mortality from the years 2000 to 2016 amongst both the genders in four racial groups. Methods The Surveillance, Epidemiology, and End Results (SEER) database was utilized to conduct a nation-wide analysis for the years 2000 to 2016. Incidence-based mortality for all stages of well-differentiated and undifferentiated thyroid cancer was queried and the results were grouped by race (Caucasian/White, African American/Black, American Indian/Alaskan Native and Asian/Pacific Islander) and gender. All stages and ages were included in the analysis. Two sample t-test was used to determine statistically significant difference between various subgroups. Results Incidence-based mortality rates (per 100,000) for well-differentiated and undifferentiated thyroid cancer for all races and both the genders were calculated. The incidence-based mortality rates for both genders are approximately the same despite a 2–3:1 difference in incidence. Anaplastic thyroid cancer has a higher mortality rate in Caucasian and Asian/Pacific Islander women compared to men despite an equal ratio in incidence. As expected, the mortality rates of anaplastic thyroid cancer were significantly higher compared to well-differentiated cancer across all races and genders. Also, Asian/Pacific Islander women have a higher rate of mortality compared to both the genders of Caucasian and African American races. Conclusion Incidence-based mortality for anaplastic thyroid cancer is higher in women in all races whereas there is no difference in mortality between men and women for well-differentiated thyroid cancer. This is divergent from the incidence ratios noted in these malignancies. In the context of increasing incidence of thyroid cancer for the past few decades, this data suggests that additional resources may be devoted to decreasing the disparity of mortality in this gender.
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Affiliation(s)
- Sunny Patel
- Department of Hematology/Oncology, Medical College of Georgia, Augusta University, Augusta, GA 30909, USA
| | - Lakshmi Pappoppula
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University, Augusta, GA 30909, USA
| | - Achuta Kumar Guddati
- Department of Hematology/Oncology, Georgia Cancer Center, Augusta University, Augusta, GA 30909, USA
| | - Pavan Annamaraju
- Johnston Memorial Hospital Ballad Health System, Abingdon, VA 24211, USA
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10
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Papaleontiou M, Evron JM, Esfandiari NH, Reyes-Gastelum D, Ward KC, Hamilton AS, Worden F, Haymart MR. Patient Report of Recurrent and Persistent Thyroid Cancer. Thyroid 2020; 30:1297-1305. [PMID: 32183609 PMCID: PMC7482108 DOI: 10.1089/thy.2019.0652] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Despite the excellent survival of most patients with differentiated thyroid cancer (DTC), recurrent and persistent disease remain major concerns for physicians and patients. However, studies on patient report of recurrent and persistent disease are lacking. Methods: Between February 1, 2017, and October 31, 2018, we surveyed eligible patients who were diagnosed with DTC between 2014 and 2015 from the Georgia and Los Angeles Surveillance, Epidemiology, and End Results cancer registries (N = 2632; response rate, 63%). Patients who reported current disease status were included in this study (n = 2454). Patient-reported data were linked to registry data. A multivariable, multinomial logistic regression analysis was conducted to determine patient and tumor characteristics associated with recurrent and persistent thyroid cancer. Quality of life was evaluated using the Patient-Reported Outcomes Measurement Information System-Global Health v1.2 questionnaire. Meaningful change in global health was defined as a minimal difference of a half standard deviation or 5 points compared with the mean (T score = 50) of a sample population matching the United States 2000 General Census. Results: Of the 2454 patients completing the survey, 95 (4.1%) reported recurrent disease and 137 (5.8%) reported persistent disease. In multinomial analyses, T3/T4 classification and cervical lymph node involvement (N1) were associated with both report of recurrent (adjusted relative risk ratio [RRR] 1.99, 95% confidence interval [CI 1.16-3.42]; adjusted RRR 2.03 [CI 1.29-3.21], respectively) and persistent disease (adjusted RRR 3.48 [CI 1.96-6.20]; adjusted RRR 3.56 [CI 2.41-5.24], respectively). Additionally, Hispanic ethnicity was associated with report of recurrent disease (adjusted RRR 1.99 [CI 1.23-3.24]). Regarding quality of life, the median scores in patients with persistent disease met criteria for meaningful change in global physical health (T-score = 44.9) and global mental health (T-score = 43.5) when compared with the general population norms. Median scores in patients with cured or recurrent disease did not meet criteria for meaningful change. Conclusions: Patient report is a reasonable method of assessing recurrent and persistent disease. Impact on quality of life is more marked for patients with reported persistent disease. Our findings will help personalize treatment and long-term follow-up in these patients.
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Affiliation(s)
- Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Josh M. Evron
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Nazanene H. Esfandiari
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - David Reyes-Gastelum
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kevin C. Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ann S. Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Francis Worden
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Megan R. Haymart
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Address correspondence to: Megan R. Haymart, MD, Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 408E, Ann Arbor, MI 48109
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11
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Joseph-Auguste J, Lin L, Demar M, Duffas O, Molinie V, Sulpicy C, Dorival MJ, Luxembourger O, Sabbah N. Epidemiologic, Clinical, Ultrasonographic, and Cytological Features of Thyroid Nodules in Predicting Malignancy Risk: A Retrospective Study of 442 French Afro-Caribbean Patients. Int J Endocrinol 2020; 2020:4039290. [PMID: 32318106 PMCID: PMC7150686 DOI: 10.1155/2020/4039290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/11/2019] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To evaluate epidemiologic, clinical, cytological, and ultrasonographic features of thyroid nodules in a sample French Afro-Caribbean population to determine if the standard criteria for predicting malignancy risk are applicable to this specific ethnic population. Methods and Design. This retrospectively designed study consisted of 442 patients who had consulted with the Endocrinology Department in Martinique (French overseas department) between 2007 and 2011. Of the 442 patients, 641 ultrasound-guided fine-needle aspirations (US-FNA) were performed by two experienced endocrinologists, and 212 patients underwent surgery. The geographical situation, age, gender of the patient, clinical and ultrasonographic features, TSH level, and US-FNA results were considered and cross-referenced with their pathology results. RESULTS The overall malignancy rate on final histopathology was 9% (women only), 80% of which were papillary cancer, and 20% were follicular cancer. Occult micropapillary carcinoma represented 35% of the papillary cancer. There was no significant difference in age, nodule localization, number of nodules, or thyroid function test between benign and malignant nodules. Contrary to the literature, we found only 12% incidentaloma in our series, while more than half of the nodules were discovered on palpation or as a clinical symptom. Hypoechogenicity in solid pattern nodules and nodules between 2 and 3 cm in size revealed a high diagnostic value in detecting malignancy. The corresponding rate of malignancy on Bethesda system histopathologic examination was as follows: 0% in undiagnosed (I), 0% benign (II) (micropapillary), 5% (FLUS)/atypia (III), 9% follicular neoplasm (IV), 33% suspected malignancy (V), and no malignant cytology (VI). These results show a different Bethesda system predictive value for this French Afro-Caribbean population. CONCLUSION Studies evaluating ethnic cancer disparities among patients with thyroid cancer are limited and do not specifically focus on the French Afro-Caribbean population. Despite rare thyroid incidentaloma, 35% of the papillary cancer cases were micropapillary carcinoma, and the incidence and standardized mortality rate in Martinique are lower than in metropolitan France. The malignant risk distribution of thyroid FNA Bethesda classification in this sample population differs from the standard risk, and it is necessary to take that into account in the decision to operate by associating it with echographic malignancy criteria.
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Affiliation(s)
- Johan Joseph-Auguste
- Department of Endocrinology and Metabolic Diseases, University Hospital Center, Louis Domergues, La Trinité, Martinique
| | - Lucien Lin
- Department of Endocrinology and Metabolic Diseases, University Hospital Center, Louis Domergues, La Trinité, Martinique
| | - Magalie Demar
- EA3593, Amazon Ecosystems and Tropical Diseases, University of French Guiana, Cayenne, French Guiana
| | - Olivier Duffas
- Department of Otorhinolaryngology, University Hospital Center, Pierre Zobda Quitman, Fort-de-France, Martinique
| | - Vincent Molinie
- Department of Anatomopathology, University Hospital Center, Pierre Zobda Quitman, Fort-de-France, Martinique
| | | | | | - Olivier Luxembourger
- Department of General Surgery, University Hospital Center, Louis Domergues, La Trinité, Martinique
| | - Nadia Sabbah
- Department of Endocrinology and Metabolic Diseases, University Hospital Center, Louis Domergues, La Trinité, Martinique
- EA3593, Amazon Ecosystems and Tropical Diseases, University of French Guiana, Cayenne, French Guiana
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital, Andre Rosemon, French Guiana
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12
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Moten AS, Zhao H, Intenzo CM, Willis AI. Disparity in the use of adjuvant radioactive iodine ablation among high-risk papillary thyroid cancer patients. Eur J Surg Oncol 2019; 45:2090-2095. [DOI: 10.1016/j.ejso.2019.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/20/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022] Open
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13
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Asban A, Chung SK, Xie R, Lindeman BM, Balentine CJ, Kirklin JK, Chen H. Gender and Racial Disparities in Survival After Surgery Among Papillary and Patients With Follicular Thyroid Cancer: A 45-Year Experience. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2019; 12:1179551419866196. [PMID: 31598065 PMCID: PMC6764040 DOI: 10.1177/1179551419866196] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 11/16/2022]
Abstract
Background Demographic disparities have been described for survival after thyroid cancer surgery using national registries and databases. At the institution level, we hypothesized that assessing survival after thyroid cancer surgery in a long-term cohort with diverse gender and racial groups would reveal disparities in survival. Methods We examined medical records of patients with papillary or follicular thyroid cancer undergoing thyroidectomy, lobectomy, and other surgical procedures from 1971 to 2016 at a tertiary referral center. We obtained information on demographics, cancer stage, procedure, and radioactive iodine (RAI). We measured survival using Kaplan-Meier estimates and Cox proportional hazards models. Results A total of 1440 (91%) patients with papillary cancer and 144 (9%) patients with follicular thyroid cancer underwent total thyroidectomy (1297, 82%), lobectomy (261, 16.5%), and other surgical procedures (26, 1.5%). Most patients (1131, 71%) were woman, and 909 (57%) were older than 45 years. Race/ethnicity included 805 (51%) white, 161 (10%) African Americans, and 618 (39%) other race/ethnicities. Both 10- and 20-year survival rates in nonwhite males were worse compared with nonwhite females (P < .0001). After controlling for age, cancer type, stage, surgical procedure, RAI, and year of surgery, nonwhite males had a higher mortality risk compared with nonwhite females (P = .0376, confidence interval (CI): 1.03-2.43), white males (P < .0001, CI: 1.88-6.54), and white females (P < .0001, CI: 3.31-9.90). Conclusions Our diverse cohort demonstrates significant gender and racial disparities in survival after thyroid cancer surgery. To improve health outcomes and reduce health disparities among nonwhite males, interventions and long-term care management should target potentially modifiable causes of worse outcomes in this group.
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Affiliation(s)
- Ammar Asban
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sebastian K Chung
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rongbing Xie
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA.,Kirklin Institute for Research in Surgical Outcomes, Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brenessa M Lindeman
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Courtney J Balentine
- Dallas VA Hospital and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James K Kirklin
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA.,Kirklin Institute for Research in Surgical Outcomes, Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Herbert Chen
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
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14
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Huang M, Yan C, Wei H, Lv Y, Ling R. Clinicopathological characteristics and prognosis of thyroid cancer in northwest China: A population-based retrospective study of 2490 patients. Thorac Cancer 2018; 9:1453-1460. [PMID: 30209893 PMCID: PMC6209792 DOI: 10.1111/1759-7714.12858] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/02/2018] [Accepted: 08/04/2018] [Indexed: 02/06/2023] Open
Abstract
Background The specific clinical features of thyroid cancer patients in northwest China are unclear; therefore, we analyzed the clinicopathological characteristics and prognosis of this population. Methods Clinical characteristics including age, gender, blood type, histological type, and BRAFV600E gene mutation; and incidence; risk factors; surgical treatment; and prognosis were recorded. Results A total of 2490 thyroid cancer patients were included; 98% were diagnosed with papillary thyroid cancer (PTC). Weight, blood type, histological type, and BRAFV600E gene mutation rates were significantly different. Pediatric thyroid cancer patients had higher lymph node metastasis, lower BRAFV600E mutation, and 6.2–9.2% greater recurrence rates than adult patients. PTC and papillary thyroid microcarcinoma displayed similar features, while in other types, such as follicular and medullary thyroid cancer, there were variations. Multiple logistic analyses showed that age (odds ratio [OR] 0.957, 95% confidence interval [CI] 0.944–0.970; P < 0.001), focal status (OR 16.174, 95% CI 9.257–28.262; P < 0.001), pathology (OR 0.642, 95% CI 0.473–0.871; P = 0.004) and lymph node metastasis (OR 0.059, 95% CI 0.033–0.107; P < 0.001) were independent factors for BRAFV600E mutation. Conclusion Most real world clinicopathological features, treatment, and prognosis of thyroid cancer are similar to reported data, such as the higher incidence of disease in women and the larger proportion of PTC. However, the results in pediatric patients and those with BRAF gene mutations are controversial and require more clinical incidence.
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Affiliation(s)
- Meiling Huang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Changjiao Yan
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Hongliang Wei
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Yonggang Lv
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Rui Ling
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, China
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15
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Shulin JH, Aizhen J, Kuo SM, Tan WB, Ngiam KY, Parameswaran R. Rising incidence of thyroid cancer in Singapore not solely due to micropapillary subtype. Ann R Coll Surg Engl 2018. [PMID: 29543059 DOI: 10.1308/rcsann.2018.0004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction The annual incidence of thyroid cancer is known to vary with geographic area, age and gender. The increasing incidence of thyroid cancer has been attributed to increase in detection of micropapillary subtype, among other factors. The aim of the study was to investigate time trends in the incidence of thyroid cancer in Singapore, an iodine-sufficient area. Materials and methods Data retrieved from the Singapore National Cancer Registry on all thyroid cancers that were diagnosed from 1974 to 2013 were reviewed. We studied the time trends of thyroid cancer based on gender, race, pathology and treatment modalities where available. Results The age-standardised incidence rate of thyroid cancer increased to 5.6/100,000 in 2013 from 2.5/100,000 in 1974. Thyroid cancer appeared to be more common in women, with a higher incidence in Chinese and Malays compared with Indians. Papillary carcinoma is the most common subtype. The percentage of papillary microcarcinoma has remained relatively stable at around 38% of all papillary cancers between 2007 and 2013. Although the incidence of thyroid cancer has increased since 1974, the mortality rate has remained stable. Conclusion This trend of increase in incidence of thyroid cancer in Singapore compares with other published series; however, the rise seen was not solely due to micropapillary type. Thyroid cancer was also more common in Chinese and Malays compared with Indians for reasons that needs to be studied further.
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Affiliation(s)
- J H Shulin
- Division of Endocrine Surgery, National University Hospital , Singapore
| | - J Aizhen
- National Registry of Disease Office, Health Promotion Board , Singapore
| | - S M Kuo
- National Registry of Disease Office, Health Promotion Board , Singapore
| | - W B Tan
- Division of Endocrine Surgery, National University Hospital , Singapore
| | - K Y Ngiam
- Division of Endocrine Surgery, National University Hospital , Singapore
| | - R Parameswaran
- Division of Endocrine Surgery, National University Hospital , Singapore
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16
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Tang J, Kong D, Cui Q, Wang K, Zhang D, Liao X, Gong Y, Wu G. Racial disparities of differentiated thyroid carcinoma: clinical behavior, treatments, and long-term outcomes. World J Surg Oncol 2018; 16:45. [PMID: 29506526 PMCID: PMC5836433 DOI: 10.1186/s12957-018-1340-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/14/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The incidence of thyroid cancer in black Americans is significantly lower than that in white Americans, and the impact of race on the prognosis of thyroid cancer remains controversial. The purpose of this study was to determine the risk factors for survival in black and white patients and to compare the survival of differentiated thyroid carcinoma subtypes between these two races. We further investigated the association of lymph node and distant metastases with races. METHODS This is a retrospective analysis using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. A total of 70,346 cases were included in our study. Patients' demographics and cancer- and treatment-related characteristics were compared between the black and white Americans using chi-square and Fisher's exact tests. For multivariate analysis, Cox proportional hazards regression were used to assess the association between potential risk factors and the survival in black and white patients. RESULT Black Americans had a worse overall survival than white Americans (HR = 1.127, P = 0.002). While disease-specific survival (DSS) was comparable, the risk factors for DSS were different between white and black Americans. Black Americans had less lymph node metastasis of classical variant papillary thyroid carcinoma (CPTC, OR = 0.476, P < 0.001) and follicular variant papillary thyroid carcinoma (FVPTC, OR = 0.522, P < 0.001), but not follicular thyroid carcinoma (FTC). However, black Americans with FVPTC, but not CPTC or FTC, had a higher potential of distant metastasis (OR = 1.715, P = 0.026). Furthermore, only white patients with tumor > 2 cm and lymph node metastasis benefited from radioactive iodine. CONCLUSIONS The risk factors for DSS were significantly different in white and black patients. The impact of race should be considered in treatment strategy for thyroid cancer.
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Affiliation(s)
- Jianing Tang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China
| | - Deguang Kong
- Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Qiuxia Cui
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China
| | - Kun Wang
- Department of Thyroid and Breast Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dan Zhang
- Department of Thyroid and Breast Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xing Liao
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China
| | - Yan Gong
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China.
| | - Gaosong Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China.
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17
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Shah SA, Adam MA, Thomas SM, Scheri RP, Stang MT, Sosa JA, Roman SA. Racial Disparities in Differentiated Thyroid Cancer: Have We Bridged the Gap? Thyroid 2017; 27:762-772. [PMID: 28294040 DOI: 10.1089/thy.2016.0626] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Racial disparities in the management of differentiated thyroid cancer (DTC) exist in the United States. There is a paucity of data examining their temporal trends. It was hypothesized that racial disparities in care provided to patients with DTC have improved over the past 15 years. METHODS Adult patients undergoing surgery for DTC were included from the National Cancer Data Base (1998-2012). Temporal trends in appropriate extent of thyroidectomy and radioactive iodine therapy (RAI) were described for different racial groups. Multivariable logistic regression models were employed to estimate the adjusted association of receipt of appropriate extent of surgery and RAI, specifically under- and over-treatment, among different racial groups. RESULTS Among 282,043 DTC patients, 80.3% were non-Hispanic white (white), 8.1% Hispanic, 7.2% non-Hispanic black (black), and 4.4% Asian. Black versus white race/ethnicity was associated with lower odds of receiving appropriate surgery (odds ratio [OR] = 0.78 [confidence interval (CI) 0.71-0.87]; p < 0.001). Appropriate RAI treatment was higher in blacks (OR = 1.07 [CI 1.02-1.12]; p = 0.01) and lower for Hispanics (OR = 0.90 [CI 0.86-0.95]; p < 0.001) compared with whites. There was a higher likelihood of RAI under-treatment in minority groups (Hispanic OR = 1.27, black OR = 1.26, Asian OR = 1.25; p < 0.001), and a lower likelihood of RAI over-treatment (Hispanic OR = 0.89, black OR = 0.83, Asian OR = 0.79; p < 0.001) compared with whites. Over time, an increasing proportion of black and white patients underwent appropriate extent of thyroidectomy (1998 vs. 2012: 78% vs. 88% and 81% vs. 91%, respectively). Compared with 1998, fewer patients in 2012 were under-treated with RAI: whites (48% vs. 29%, respectively), blacks (51% vs. 33%), Hispanics (51% vs. 37%), and Asians (55% vs. 39%). The extent of RAI over-treatment increased (1998 vs. 2012): whites (1% vs. 4%), blacks (2% vs. 4%), Hispanics (2% vs. 4%), and Asians (2% vs. 3%), respectively. CONCLUSIONS Appropriate utilization of surgery and RAI for DTC has improved over time. However, the proportion of patients receiving appropriate thyroid surgery is consistently lower for blacks compared with whites. RAI over-treatment increased for all races over the study period. Efforts are needed to standardize DTC care among minority patients.
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Affiliation(s)
- Syed A Shah
- 1 Department of Surgery Virginia Commonwealth University , VCU Medical Center, Richmond, Virginia
| | - Mohamed A Adam
- 2 Department of Surgery, Duke University , Duke University Medical Center, Durham, North Carolina
| | - Samantha M Thomas
- 3 Department of Biostatistics, Duke University , Duke University Medical Center, Durham, North Carolina
- 4 Department of Bioinformatics, Duke University , Duke University Medical Center, Durham, North Carolina
| | - Randall P Scheri
- 2 Department of Surgery, Duke University , Duke University Medical Center, Durham, North Carolina
| | - Michael T Stang
- 2 Department of Surgery, Duke University , Duke University Medical Center, Durham, North Carolina
| | - Julie A Sosa
- 2 Department of Surgery, Duke University , Duke University Medical Center, Durham, North Carolina
- 5 Department of Medicine (Oncology), Duke University , Duke University Medical Center, Durham, North Carolina
| | - Sanziana A Roman
- 2 Department of Surgery, Duke University , Duke University Medical Center, Durham, North Carolina
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Abstract
BACKGROUND The incidence of thyroid cancer is increasing. There is conflicting evidence as to why. However, studies suggest that it is not an apparent increase resulting from enhanced diagnostic practices, but a true increase with more affected patients. This study aimed to assess racial variation in thyroid cancer. METHOD A narrative systematic review of the literature was conducted. RESULTS Eight retrospective cohort studies were identified, comprising 611 777 adult patients. Variations exist between racial groups, which are also dependent on gender; white patients have a slightly higher male population when compared to their counterparts. Black and white patients have a higher proportion of follicular cancer. Hispanics were younger at the age of diagnosis. Outcomes are greatly affected by socioeconomic status. CONCLUSION This study identified many gaps in the way that these types of data are presented. A more concise manner of reporting, with individual-level risk factors, is recommended.
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Casellas-Cabrera N, Díaz-Algorri Y, Carlo-Chévere VJ, González-Pons M, Rodríguez-Mañón N, Pérez-Mayoral J, Bertrán-Rodríguez C, Soto-Salgado M, Giardiello FM, Rodríguez-Quilichini S, Cruz-Correa M. Risk of thyroid cancer among Caribbean Hispanic patients with familial adenomatous polyposis. Fam Cancer 2016; 15:267-74. [PMID: 26690363 DOI: 10.1007/s10689-015-9862-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Familial adenomatous polyposis (FAP) is an inherited form of colorectal cancer characterized by hundreds of adenomatous polyps in the colon and rectum. FAP is also associated with thyroid cancer (TC), but the lifetime risk is still unclear. This study reports the standardized incidence ratio (SIR) of TC in Hispanic FAP patients. TC incidence rates in patients with FAP between the periods of January 1, 2006 to December 31, 2013 were compared with the general population through direct database linkage from the Puerto Rico Central Cancer Registry (PRCCR) and the Puerto Rico Familial Colorectal Cancer Registry (PURIFICAR). The study population consisted of 51 Hispanic patients with FAP and 3239 with TC from the general population. The SIR was calculated using the Indirect Method, defined as observed TC incidence among patients with FAP in PURIFICAR's cohort (2006-2013) divided by the expected TC incidence based on the PR population rates (2006-2010). SIR values were estimated by sex (male, female, and overall). This study received IRB approval (protocol #A2210207). In Hispanic patients with FAP, the SIR (95% CI) for TC was 251.73 (51.91-735.65), with higher risk for females 461.18 (55.85-1665.94) than males 131.91 (3.34-734.95). Hispanic FAP patients are at a high risk for TC compared to the general population. Our incidence rates are higher than previous studies, suggesting that this community may be at a higher risk for TC than previously assumed. Implementation of clinical surveillance guidelines and regular ultrasound neck screening in Hispanic FAP patients is recommended.
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Affiliation(s)
- Nicolás Casellas-Cabrera
- University of Puerto Rico Comprehensive Cancer Center, PMB 711 Ave. 89 Ste. 105, San Juan, PR, 00927-6346, USA
| | - Yaritza Díaz-Algorri
- University of Puerto Rico Comprehensive Cancer Center, PMB 711 Ave. 89 Ste. 105, San Juan, PR, 00927-6346, USA
| | - Víctor J Carlo-Chévere
- Puerto Rico Pathology, 1760 Calle Loíza Cond. Madrid Suite 206, San Juan, PR, 00911, USA
| | - María González-Pons
- University of Puerto Rico Comprehensive Cancer Center, PMB 711 Ave. 89 Ste. 105, San Juan, PR, 00927-6346, USA
- UPR/MDACC Partnership for Excellence in Cancer Research Program, University of Puerto Rico, Medical Sciences Campus, PMB 371 PO BOX 70344, San Juan, PR, 00936-8344, USA
| | - Natalia Rodríguez-Mañón
- University of Puerto Rico Comprehensive Cancer Center, PMB 711 Ave. 89 Ste. 105, San Juan, PR, 00927-6346, USA
- UPR/MDACC Partnership for Excellence in Cancer Research Program, University of Puerto Rico, Medical Sciences Campus, PMB 371 PO BOX 70344, San Juan, PR, 00936-8344, USA
| | - Julyann Pérez-Mayoral
- University of Puerto Rico Comprehensive Cancer Center, PMB 711 Ave. 89 Ste. 105, San Juan, PR, 00927-6346, USA
| | - Carlos Bertrán-Rodríguez
- University of Puerto Rico Comprehensive Cancer Center, PMB 711 Ave. 89 Ste. 105, San Juan, PR, 00927-6346, USA
| | - Marievelisse Soto-Salgado
- UPR/MDACC Partnership for Excellence in Cancer Research Program, University of Puerto Rico, Medical Sciences Campus, PMB 371 PO BOX 70344, San Juan, PR, 00936-8344, USA
- Doctoral Program in Public Health with Specialty in Social Determinants of Health, Department of Social Sciences, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, PO BOX 365067, San Juan, PR, 00936-5067, USA
| | - Francis M Giardiello
- Division of Gastroenterology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street Sheikh Zayed Tower, Baltimore, MD, 21287, USA
| | - Segundo Rodríguez-Quilichini
- Department of Surgery, University of Puerto Rico, Medical Sciences Campus, PO BOX 365067, San Juan, PR, 00936-5067, USA
| | - Marcia Cruz-Correa
- University of Puerto Rico Comprehensive Cancer Center, PMB 711 Ave. 89 Ste. 105, San Juan, PR, 00927-6346, USA.
- Department of Medicine, University of Puerto Rico, Medical Sciences Campus, PO BOX 365067, San Juan, PR, 00936-5067, USA.
- Department of Biochemistry, University of Puerto Rico, Medical Sciences Campus, PO BOX 365067, San Juan, PR, 00936-5067, USA.
- Department of Surgery, University of Puerto Rico, Medical Sciences Campus, PO BOX 365067, San Juan, PR, 00936-5067, USA.
- UPR/MDACC Partnership for Excellence in Cancer Research Program, University of Puerto Rico, Medical Sciences Campus, PMB 371 PO BOX 70344, San Juan, PR, 00936-8344, USA.
- Division of Gastroenterology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street Sheikh Zayed Tower, Baltimore, MD, 21287, USA.
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Racial disparities in papillary thyroid microcarcinoma survival. The Journal of Laryngology & Otology 2016; 131:83-87. [PMID: 27917722 DOI: 10.1017/s0022215116009737] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the impact of race on survival in patients with papillary thyroid microcarcinoma. METHODS The study cohort included 17 668 patients diagnosed with papillary thyroid microcarcinoma between 1988 and 2009, identified in the Surveillance, Epidemiology, and End Results 18 database of the National Cancer Institute. RESULTS Black patients had lower overall survival than other racial groups (p < 0.001). Black patients had significantly worse overall survival (hazard ratio = 2.59) after adjusting for sex, marital status, age, year of diagnosis, multifocal disease and type of surgery. A subset analysis of Black patients revealed no significant difference in overall survival for total thyroidectomy versus lobectomy (p = 0.15). CONCLUSION Black race is a negative prognostic factor in thyroid cancer, which cannot be explained by advanced disease stage. Further research on mechanisms by which race affects survival is needed to reveal areas of opportunity for interventions aimed at reducing health disparities in cancer care.
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De Oliveira GS, McCarthy RJ, Wolf MS, Holl J. The impact of health literacy in the care of surgical patients: a qualitative systematic review. BMC Surg 2015; 15:86. [PMID: 26182987 PMCID: PMC4504415 DOI: 10.1186/s12893-015-0073-6] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 07/09/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Inadequate health literacy affects more than 90 million Americans and it has been associated with adverse outcomes in the medicine field including increased hospitalization rates and greater mortality. Since surgical patients are often required to make complex decisions and adhere to complex instructions, health literacy may have a profound impact in the surgical practice. The main objective of the current study was to systematically evaluate the role of health literacy in surgical patients. METHODS A systematic search was performed to identify studies that evaluated the role of health literacy in the perioperative setting following the PRISMA guidelines. Only studies that examined health literacy using a validated instrument in the perioperative setting were included. RESULTS Ten studies including data on 1147 patients were included. The median (IQR) number of patients in the included studies was 101 (30 to 152). The majority of studies used the Short Test of Functional Literacy in adults (STOFHLA) to evaluate patients' health literacy. Five studies evaluated the patients preoperatively, four studies evaluated patients in the postoperative period and in one study the time of evaluation in relation to the surgical procedure was not defined. The lowest prevalence of inadequate health literacy was detected in kidney transplant patients, 6 out of 124 (5 %), while the highest prevalence of inadequate health literacy was detected in orthopedic patients having total joint replacement, 86 out of 126 (60 %). Inadequate health literacy in the preoperative period was associated with poor medical information comprehension and it may adversely affect adherence to preoperative medications and even modulate surgical disparities. Inadequate health literacy in the postoperative period was associated with poor comprehension of discharge instructions and worse kidney function in transplant recipients. CONCLUSIONS Health literacy seems to have a very significant impact in the care of surgical patients. More studies to establish the impact of poor health literacy on perioperative outcomes are needed.
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Affiliation(s)
- Gildasio S De Oliveira
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, 241 East Huron St, F5-704, Chicago, IL, USA.
| | - Robert J McCarthy
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, 241 East Huron St, F5-704, Chicago, IL, USA
| | - Michael S Wolf
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jane Holl
- Center for Health Care studies, Northwestern University, Chicago, USA
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