Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.
J Clin Endocrinol Metab. 2013 May;98(5):2001-8. doi: 10.1210/jc.2012-3355. Epub 2013 Mar 28.
Little is known about practice patterns in thyroid cancer, a cancer that is increasing in incidence.
We sought to identify aspects of thyroid cancer management that have the greatest variation.
DESIGN/SETTING/PARTICIPANTS: We surveyed 944 physicians involved in thyroid cancer care from 251 hospitals affiliated with the US National Cancer Database. Physicians were asked questions in the following four domains: thyroid surgery, radioactive iodine use, thyroid hormone replacement postsurgery, and long-term thyroid cancer management. We calculated the ratio of observed variation to hypothetical maximum variation under the assumed distribution of the response. Ratios closer to 1 indicate greater variation.
We had a 66% response rate. We found variation in multiple aspects of thyroid cancer management, including the role of central lymph node dissections (variation, 0.99; 95% confidence interval [CI], 0.98-1.00), the role of pretreatment scans before radioactive iodine treatment (variation, 1.00; 95% CI, 0.98-1.00), and all aspects of long-term thyroid cancer management, including applications of ultrasound (variation, 0.97; 95% CI, 0.93-0.99) and radioactive iodine scans (variation, 0.99; 95% CI, 0.97-1.00). For the management of small thyroid cancers, variation exists in all domains, including optimal extent of surgery (variation, 0.91; 95% CI, 0.88-0.94) and the role of both radioactive iodine treatment (variation, 0.91; 95% CI, 0.89-0.93) and suppressive doses of thyroid hormone replacement (variation, 1.00; 95% CI, 0.99-1.00).
We identified areas of variation in thyroid cancer management. To reduce the variation and improve the management of thyroid cancer, there is a need for more research and more research dissemination.
甲状腺癌的发病率正在上升，但人们对其治疗方法知之甚少。
我们旨在确定甲状腺癌治疗中差异最大的方面。
设计/环境/参与者：我们调查了美国国家癌症数据库中 251 家附属医院的 944 名参与甲状腺癌治疗的医生。医生们在以下四个领域回答了问题：甲状腺手术、放射性碘的使用、手术后甲状腺激素替代以及长期甲状腺癌管理。我们计算了观察到的变异与假设反应分布下的最大变异比值。比值越接近 1，则表示差异越大。
我们的响应率为 66%。我们发现甲状腺癌管理的多个方面存在差异，包括中央淋巴结清扫术的作用（变异比为 0.99；95%置信区间[CI]，0.98-1.00）、放射性碘治疗前预处理扫描的作用（变异比为 1.00；95%CI，0.98-1.00）以及长期甲状腺癌管理的所有方面，包括超声（变异比为 0.97；95%CI，0.93-0.99）和放射性碘扫描（变异比为 0.99；95%CI，0.97-1.00）的应用。对于小甲状腺癌的治疗，所有领域都存在差异，包括手术的最佳范围（变异比为 0.91；95%CI，0.88-0.94）以及放射性碘治疗（变异比为 0.91；95%CI，0.89-0.93）和甲状腺激素抑制剂量替代（变异比为 1.00；95%CI，0.99-1.00）的作用。
我们确定了甲状腺癌治疗中存在差异的领域。为了减少差异并改善甲状腺癌的治疗，需要进行更多的研究和研究传播。
