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

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.