Division of Endocrinology, Mayo Clinic, Jacksonville, Florida.
Division of Hematology-Oncology, Mayo Clinic, Jacksonville, Florida.
Cancer. 2021 Jun 1;127(11):1770-1778. doi: 10.1002/cncr.33408. Epub 2021 Jan 15.
Factors associated with receiving initial care for thyroid cancer (TC) at academic centers (ACs) versus nonacademic centers (NACs) and their impact on patient outcomes have not been reported.
The National Cancer Database with TC cases from 2004 to 2013 was evaluated for association of type of center for initial care with socioeconomic factors and disease and treatment characteristics, as well as overall survival (OS; all-cause mortality).
The patients with TC (n = 200,824) included were predominantly women (74%), non-Hispanic Whites (85%), and from metro areas (84%). Sixty percent received initial care at a NAC. There were no significant differences between treatment groups by age or gender. Among those treated at an AC, a higher proportion belonged to racial/ethnic minorities (16.5%) versus at a NAC (11.6%). Hormone therapy was used more in an AC versus a NAC (60% vs 47%). Patients with all TC pathologies combined had a lower likelihood of death when they received initial care at an AC (hazard ratio [HR], 0.948; P = .0006). Among individual pathologic subtypes, a lower likelihood of death was noted when initial care was received at an AC for follicular (HR, 0.828, P = .0010) and Hurthle cell cancers (HR, 792; P = .0008), as well as stage II papillary thyroid cancer (HR, 0.828; P = .0026), but not for other histopathologic subtypes.
Initial care at an AC was associated with lower likelihood of death for patients with TC, especially for those with follicular or Hurthle cell subtypes. Optimal resource use with consideration of patients' socioeconomic and demographic factors is imperative to ensure the most appropriate management of patients with TC in various treatment settings.
接受甲状腺癌（TC）初始治疗的中心类型（学术中心[AC]与非学术中心[NAC]）与患者结局相关的因素及其对患者结局的影响尚未报道。
评估了 2004 年至 2013 年国家癌症数据库中 TC 病例，以确定初始治疗中心类型与社会经济因素以及疾病和治疗特征的关联，以及总生存率（OS；全因死亡率）。
TC 患者（n=200824）主要为女性（74%）、非西班牙裔白人（85%）和大都市区（84%）。60%的患者在 NAC 接受初始治疗。两组间在年龄或性别上无显著差异。在 AC 治疗的患者中，属于少数民族的比例更高（16.5% vs. NAC 为 11.6%）。与 NAC 相比，AC 更常使用激素治疗（60% vs. 47%）。所有 TC 病理类型综合患者在 AC 接受初始治疗时，死亡的可能性更低（风险比[HR]，0.948；P=0.0006）。在各个病理亚型中，在 AC 接受初始治疗时，滤泡性（HR，0.828，P=0.0010）和 Hurthle 细胞癌（HR，792；P=0.0008）以及 II 期甲状腺乳头状癌（HR，0.828；P=0.0026）患者死亡的可能性较低，但其他组织病理学亚型除外。
AC 初始治疗与 TC 患者死亡的可能性降低相关，尤其是滤泡性或 Hurthle 细胞亚型患者。在各种治疗环境中，考虑患者的社会经济和人口统计学因素，以优化资源利用，对于确保 TC 患者获得最合适的治疗至关重要。
