甲状腺癌治疗结果中的种族差异：一项系统评价。
Racial disparities in thyroid cancer outcomes: A systematic review.
作者信息
Zmijewski Polina, Nwaiwu Chibueze, Nakanishi Hayato, Farsi Soroush, Fazendin Jessica, Lindeman Brenessa, Chen Herbert, Gillis Andrea
机构信息
Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Surgery, Brown University/ Rhode Island Hospital, Providence, RI, USA.
出版信息
Am J Surg. 2025 Feb;240:115991. doi: 10.1016/j.amjsurg.2024.115991. Epub 2024 Sep 28.
INTRODUCTION
Racial disparities in surgical outcomes are well described, but a paucity of literature exists examining trends in outcomes of thyroid cancer. We performed a systematic review of studies on thyroid cancer outcomes to better delineate the impact of race.
METHODS
A comprehensive search strategy was performed in several academic databases for articles on thyroid cancer and surgical outcomes in accordance with PRISMA guidelines. A total of 1771 abstracts were reviewed. Abstracts were screened by two independent reviewers with disagreements resolved by a third. Studies that were based in the United States, included single center, unique data, focused on outcomes of differentiated thyroid cancer, were performed on adults >18 years old, and reported race in their results were included. Chi square statistics with Yates correction were calculated on the compiled data. The protocol was registered on PROSPERO (CRD42022300021).
RESULTS
Twelve studies met inclusion criteria with data on 7,221patients. Among the included studies, our study consists of 67 % White patients, 22 % Black patients, 7 % Hispanic patients, and 3 % Asian patients. Extrathyroidal extension was observed in 8.4 % (n = 13) of White patients. In comparison to White patients, Black (18.4 %, n = 21, p = 0.024) and Hispanic patients (28.3 %, n = 30, p < 0.001) had a higher incidence of extrathyroidal extension, while a similar incidence was observed in Asian patients (14.0 %, n = 8, p = 0.336). Compared to White patients (22.2 %, n = 34), Black (12.4 %, n = 13, p = 0.065), Hispanic (16.0 %, n = 15, p = 0.301), and Asian (18.4 %, n = 9, p = 0.709) patients had a similar incidence of T1a stage. White patients had 10.1 % (n = 54) recurrence rates, and Black (13.5 %, n = 7, p = 0.595), Hispanic (10.5 %, n = 2, p = 1.000), and Asian (11.1 %, n = 3, p = 1.000) patients had similar recurrence rates.
CONCLUSIONS
Race is seldom reported in outcomes on studies of thyroid cancer. From our analysis we conclude that non-White patients may have a higher risk of more advanced local disease at presentation. More data with granular detail on race is necessary to better understand racial disparities in thyroid cancer outcomes and how to alleviate them.
引言
手术结果中的种族差异已有详尽描述，但关于甲状腺癌治疗结果趋势的文献却很匮乏。我们对甲状腺癌治疗结果的研究进行了系统综述，以更好地阐明种族的影响。
方法
根据PRISMA指南，在多个学术数据库中执行了全面的检索策略，以查找有关甲状腺癌和手术结果的文章。共审查了1771篇摘要。由两名独立评审员筛选摘要，如有分歧则由第三名评审员解决。纳入的研究需基于美国，为单中心、独特数据，聚焦于分化型甲状腺癌的治疗结果，针对18岁以上成年人开展，且结果中报告了种族信息。对汇总数据计算了采用耶茨校正的卡方统计量。该方案已在PROSPERO（CRD42022300021）上注册。
结果
12项研究符合纳入标准，涉及7221例患者的数据。在纳入的研究中，我们的研究包括67%的白人患者、22%的黑人患者、7%的西班牙裔患者和3%的亚洲患者。8.4%（n = 13）的白人患者出现甲状腺外侵犯。与白人患者相比，黑人（18.4%，n = 21，p = 0.024）和西班牙裔患者（28.3%，n = 30，p < 0.001）的甲状腺外侵犯发生率更高，而亚洲患者的发生率与之相似（14.0%，n = 8，p = 0.336）。与白人患者（22.2%，n = 34）相比，黑人（12.4%，n = 13，p = 0.065）、西班牙裔（16.0%，n = 15，p = 0.301）和亚洲（18.4%，n = 9，p = 0.709）患者的T1a期发生率相似。白人患者的复发率为10.1%（n = 54），黑人（13.5%，n = 7，p = 0.595）、西班牙裔（10.5%，n = 2，p = 1.000）和亚洲（11.1%，n = 3，p = 1.000）患者的复发率相似。
结论
甲状腺癌研究结果中很少报告种族信息。通过我们的分析，我们得出结论，非白人患者在就诊时可能有更高风险出现更晚期的局部疾病。需要更多关于种族的详细数据，以更好地了解甲状腺癌治疗结果中的种族差异以及如何缓解这些差异。
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