Ki Wan Park1, James X Wu1, Lin Du2, Angela M Leung3,4, Michael W Yeh1, Masha J Livhits1. 1. Section of Endocrine Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California. 2. Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, California. 3. Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California. 4. Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California.
Abstract
Context: Routine radioactive iodine (RAI) ablation for low-risk differentiated thyroid cancer (DTC) is not supported by current practice guidelines. Objective: To assess recent stage-specific trends in use of RAI ablation. Design, Setting, and Patients: Retrospective study of patients with DTC (1999 to 2015) identified from the California Cancer Registry. Statistical analysis included standardized differences, P values, and multivariable analyses using RAI as the predictor variable. Main Outcome Measures: Trends and drivers of RAI ablation for low-risk DTC. Results: Of 46,906 patients with DTC who underwent near-total or total thyroidectomy [mean age 48.2 ± 15.5 (standard deviation) years, 77% female), 25,457 (54%) received RAI. The proportion of patients with regional/distant disease who received RAI remained stable at 68%. Use of RAI for patients with localized disease (no extrathyroidal extension, lymph node, or distant metastases) decreased from 55% (1999) to 30% (2015), with the most substantial change occurring in tumors <1 cm (39% to 11%). The rate also decreased for localized tumors between 1 and 2 cm (62% to 34%) and 2 and 4 cm (67% to 49%) and remained stable at 59% for tumors >4 cm. In multivariable analyses, patients with localized disease were less likely to receive RAI if they were >65 years old [odds ratio (OR) 0.77, 95% confidence interval (CI): 0.71 to 0.83], had tumors <1 cm (OR 0.33, 95% CI: 0.31 to 0.35), or were treated in an academic hospital (OR 0.71, 95% CI: 0.67 to 0.75). Conclusions: The rate of RAI ablation decreased over time, mainly attributable to decreased use for localized DTCs <2 cm. Many patients with low-risk DTC still receive RAI unnecessarily.
Context: Routine radioactive iodine (RAI) ablation for low-risk differentiated thyroid cancer (DTC) is not supported by current practice guidelines. Objective: To assess recent stage-specific trends in use of RAI ablation. Design, Setting, and Patients: Retrospective study of patients with DTC (1999 to 2015) identified from the California Cancer Registry. Statistical analysis included standardized differences, P values, and multivariable analyses using RAI as the predictor variable. Main Outcome Measures: Trends and drivers of RAI ablation for low-risk DTC. Results: Of 46,906 patients with DTC who underwent near-total or total thyroidectomy [mean age 48.2 ± 15.5 (standard deviation) years, 77% female), 25,457 (54%) received RAI. The proportion of patients with regional/distant disease who received RAI remained stable at 68%. Use of RAI for patients with localized disease (no extrathyroidal extension, lymph node, or distant metastases) decreased from 55% (1999) to 30% (2015), with the most substantial change occurring in tumors <1 cm (39% to 11%). The rate also decreased for localized tumors between 1 and 2 cm (62% to 34%) and 2 and 4 cm (67% to 49%) and remained stable at 59% for tumors >4 cm. In multivariable analyses, patients with localized disease were less likely to receive RAI if they were >65 years old [odds ratio (OR) 0.77, 95% confidence interval (CI): 0.71 to 0.83], had tumors <1 cm (OR 0.33, 95% CI: 0.31 to 0.35), or were treated in an academic hospital (OR 0.71, 95% CI: 0.67 to 0.75). Conclusions: The rate of RAI ablation decreased over time, mainly attributable to decreased use for localized DTCs <2 cm. Many patients with low-risk DTC still receive RAI unnecessarily.
Authors: Samantha A Diamond-Rossi; Jacqueline Jonklaas; Roxanne E Jensen; Charlene Kuo; Selma Stearns; Giuseppe Esposito; Bruce J Davidson; George Luta; Gary Bloom; Kristi D Graves Journal: J Cancer Surviv Date: 2020-06-06 Impact factor: 4.442
Authors: Lauren P Wallner; David Reyes-Gastelum; Ann S Hamilton; Kevin C Ward; Sarah T Hawley; Megan R Haymart Journal: J Clin Oncol Date: 2019-07-08 Impact factor: 50.717
Authors: Malik Azhar; Faisal Aziz; Salama Almuhairi; Mohammad Alfelasi; Ali Elhouni; Rizwan Syed; Humaid O Al-Shamsi; Khaled M Aldahmani Journal: Ann Med Surg (Lond) Date: 2021-03-04
Authors: Lauren P Wallner; Mousumi Banerjee; David Reyes-Gastelum; Ann S Hamilton; Kevin C Ward; Carrie Lubitz; Sarah T Hawley; Megan R Haymart Journal: J Clin Endocrinol Metab Date: 2021-05-13 Impact factor: 5.958