Exploring actionable targets to address disparities in thyroid cancer survival: A study of patients with aggressive variants of papillary thyroid cancer

Abstract

Background: Despite compromised survival, disparities studies on aggressive variants of papillary thyroid cancer (PTC) are sparse.

Methods: Using the NCDB (2004-20), adult Non-Hispanic Whites (NHW), Non-Hispanic Asians or Pacific Islanders (NHAPI), Hispanics, and Non-Hispanic Blacks (NHB) with aggressive variants were abstracted. Mortality risk was estimated using Hazard Ratios (HR).

Results: NHB patients had larger tumors (p ​< ​0.001) but lower thyroidectomy rates (p ​= ​0.04). For all patients, cancer stage posed the strongest mortality risk (HRs Stage II-IV vs. Stage I: 2.75, 4.18, 8.04, p ​< ​0.001), however, this was substantially higher by stage for NHBs (HRs Stage II-IV: 4.78, 7.57, 10.49, p ​< ​0.001). Age ≥55 years was the strongest risk factor for Hispanics (p ​< ​0.001); non-private insurance was the strongest risk factor for NHAPI, NHBs, and NHWs.

Conclusion: Beyond health insurance, actionable targets to improve PTC survival vary by race/ethnicity. For NHBs, higher clinical stage and worse survival by stage might indicate compromised access to optimal care. For Hispanics, improved follow-up, particularly for patients ≥55 years, may enhance survival.

Keywords: Aggressive variants; Endocrine surgery; Ethnicity; Papillary thyroid cancer; Race; Survival; Thyroid cancer.