A spectrum of disparities exist in the surgical management of well-differentiated thyroid cancer, according to new data presented at the 82nd Annual Meeting of the American Thyroid Association (ATA) in Québec City, Québec, Canada.
Current ATA guidelines for well-differentiated thyroid cancer recommend therapeutic neck dissection for clinically involved or metastatic disease and prophylactic central neck dissection for advanced tumors. However, even with established guidelines in place, the surgical management of cervical nodes varies greatly.
A team of researchers led by Katherine Hayes, MD, of Emory University in Atlanta, Ga., reviewed data on 127,192 patients with papillary and follicular thyroid cancer who were treated surgically from 1998 to 2009 to identify disparities in the extent of lymph node dissection during thyroidectomy. Variables examined included patient age, race, gender, insurance status and education level, hospital classification, surgical volume, and size of tumor.
Thyroidectomy alone was performed in 51.1%, while 48.9% also had lymph nodes dissected. Patients with tumors > 1 cm were significantly more likely to have nodes removed during surgery (RR 1.2, CI 1.19-1.22) relative to tumors < 1 cm. Older patients and African Americans were less likely to have any nodes removed (RR 0.75, CI 0.74-0.77 and RR 0.64, CI 0.62-0.66, respectively). Patients treated at National Cancer Institute Designated Centers were more likely (RR 1.13, CI 1.1-1.15) to have > 3 lymph nodes removed, as were patients with tumors > 1 cm (RR 1.25, CI 1.21-1.28). However, women (RR 0.87, CI 0.85-0.88) and African Americans (RR 0.89, CI 0.85-0.93) consistently had fewer lymph nodes removed.
"These new data show that, in spite of existing guidelines, clinician preferences as well as patient characteristics all too often contribute to a number of disparities in the extent of surgery for well-differentiated thyroid cancer," said Elizabeth Pearce, MD, of the Boston Medical Center and Program Co-Chair of the ATA annual meeting.