Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA.
Ann Surg Oncol. 2023 Oct;30(11):6788-6798. doi: 10.1245/s10434-023-13945-y. Epub 2023 Jul 20.
Disparities have been previously described in the presentation, management, and outcomes of other thyroid cancer subtypes; however, it is unclear whether such disparities exist in anaplastic thyroid cancer (ATC).
We identified patients with ATC from the National Cancer Database (2004-2020). The primary outcomes were receipt of surgery, chemotherapy, and radiation. The secondary outcome was 1-year survival. Multivariable logistic and Cox proportional hazards regressions were used to assess the associations between sex, race/ethnicity, and the outcomes.
Among 5359 patients included, 58% were female, and 80% were non-Hispanic white. Median tumor size was larger in males than females (6.5 vs. 6.0 cm; p < 0.001) and in patients with minority race/ethnicity than in white patients (6.5 vs. 6.0 cm; p < 0.001). After controlling for tumor size and metastatic disease, female patients were more likely to undergo surgical resection (odds ratio [OR]: 1.20; p = 0.016) but less likely to undergo chemotherapy (OR: 0.72; p < 0.001) and radiation (OR: 0.76; p < 0.001) compared with males. Additionally, patients from minority racial/ethnic backgrounds were less likely to undergo chemotherapy (OR: 0.69; p < 0.001) and radiation (OR: 0.71; p < 0.001) than white patients. Overall, unadjusted, 1-year survival was 23%, with differences in treatment receipt accounting for small but significant differences in survival between groups.
There are disparities in the presentation and treatment of ATC by sex and race/ethnicity that likely reflect differences in access to care as well as patient and provider preferences. While survival is similarly poor across groups, the changing landscape of treatments for ATC warrants efforts to address the potential for exacerbation of disparities.
其他甲状腺癌亚型在表现、治疗和预后方面存在差异；然而，间变性甲状腺癌（ATC）是否存在这种差异尚不清楚。
我们从国家癌症数据库（2004-2020 年）中确定了 ATC 患者。主要结局是接受手术、化疗和放疗。次要结局是 1 年生存率。多变量逻辑回归和 Cox 比例风险回归用于评估性别、种族/民族与结局之间的关系。
在纳入的 5359 名患者中，58%为女性，80%为非西班牙裔白人。男性的肿瘤中位数大于女性（6.5 与 6.0cm；p<0.001），少数民族裔患者的肿瘤中位数大于白人患者（6.5 与 6.0cm；p<0.001）。在控制肿瘤大小和转移性疾病后，女性患者更有可能接受手术切除（比值比[OR]：1.20；p=0.016），但不太可能接受化疗（OR：0.72；p<0.001）和放疗（OR：0.76；p<0.001），与男性相比。此外，与白人患者相比，少数族裔患者接受化疗（OR：0.69；p<0.001）和放疗（OR：0.71；p<0.001）的可能性较小。总的来说，未经调整的 1 年生存率为 23%，治疗接受率的差异导致各组之间的生存差异较小但有统计学意义。
性别和种族/民族在 ATC 的表现和治疗方面存在差异，这可能反映了获得医疗服务的差异以及患者和提供者的偏好。虽然各组的生存率相似，但 ATC 治疗方法的不断变化，需要努力解决潜在的差异加剧问题。
