The following is a summary of “Disparities in Postoperative Adjuvant Therapy Utilization and Factors Impacting Survival Among Anaplastic Thyroid Cancer Patients,” published in the September 2024 issue of Surgery by Marshall et al.

Anaplastic thyroid cancer (ATC) is an aggressive malignancy with poor survival outcomes, and adjuvant systemic therapy and radiation post-surgery are recommended by both the National Comprehensive Cancer Network (NCCN) and American Thyroid Association (ATA) guidelines. This study aimed to identify predictors of patients forgoing adjuvant therapy following thyroidectomy and to determine key factors influencing survival in patients with ATC.

Using the National Cancer Database (NCDB), researchers analyzed data from 563 patients with ATC who underwent upfront thyroidectomy between 2010 and 2017, excluding those receiving palliative care. They compared demographic, clinical, and treatment characteristics between patients who received adjuvant therapy and those who did not. Logistic regression was used to identify predictors of adjuvant therapy receipt, and Cox regression determined factors associated with survival outcomes. Of the cohort, 160 patients did not receive adjuvant therapy, 82 received radiation only, 16 received systemic therapy only, and 305 received combination therapy. Importantly, more than 75% of patients who did not receive adjuvant treatment had it omitted from their treatment plans rather than refusing it. Significant predictors of not receiving adjuvant therapy included older age (odds ratio [OR] 0.92) and non-white race/ethnicity (OR 0.33), highlighting disparities in care. Survival was improved in patients who underwent total thyroidectomy, achieved R0 or R1 resection, and received radiation or combination therapy. 

Conversely, negative predictors of survival included non-metropolitan residency, larger primary tumor size (>7.5 cm), and stage IVC disease. These findings underscore the importance of comprehensive surgical and adjuvant treatment in improving survival in ATC, while also drawing attention to the need for addressing disparities in treatment adherence, particularly for older patients and minority populations.

Source: sciencedirect.com/science/article/abs/pii/S0002961024004963