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Disparities in Presentation, Treatment, and Survival in Anaplastic Thyroid Cancer

  • Endocrine Tumors
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Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

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.

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Funding

Research reported in this publication was partially supported by the NIH National Cancer Institute grant #K08 CA270385 to HW.

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Author notes

  1. Sara P. Ginzberg and Julia A. Gasior: Co-first authors.

Authors and Affiliations

  1. Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA

    Sara P. Ginzberg MD, MS, Julia A. Gasior BS, Jesse E. Passman MD, MPH, Jacqueline M. Soegaard Ballester MD, MBMI, Caitlin B. Finn MD, Giorgos C. Karakousis MD, Rachel R. Kelz MD, MSCE, MBA & Heather Wachtel MD

  2. Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA

    Sara P. Ginzberg MD, MS & Jacqueline M. Soegaard Ballester MD, MBMI

  3. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Julia A. Gasior BS, Giorgos C. Karakousis MD, Rachel R. Kelz MD, MSCE, MBA & Heather Wachtel MD

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  1. Sara P. Ginzberg MD, MS
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Correspondence to Sara P. Ginzberg MD, MS.

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Ginzberg, S.P., Gasior, J.A., Passman, J.E. et al. Disparities in Presentation, Treatment, and Survival in Anaplastic Thyroid Cancer. Ann Surg Oncol 30, 6788–6798 (2023). https://doi.org/10.1245/s10434-023-13945-y

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