Disparities in the impact of the AJCC 8th edition staging system on differentiated thyroid cancer outcomes.

Publication Title

Head & neck

Authors

Juan A Santamaria-Barria, Department of Surgical Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA.Follow
Amanda N Graff-Baker
Shu-Ching Chang, Medical Data Research Center, Providence Health & Services, Portland, OR, USAFollow
Adam Khader, John Wayne Cancer Institute, Santa Monica, California, USAFollow
Anthony J Scholer, Department of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USAFollow
Mary Garland-Kledzik, Department of Surgical Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA.
Melanie Goldfarb, Providence St. John's Health Center, Santa Monica, CAFollow

Document Type

Article

Publication Date

6-29-2022

Keywords

oregon; portland; california; sjci; santa monica; diversity

Abstract

BACKGROUND: The impact of AJCC8 among self-reported racial/ethnic groups on differentiated thyroid cancer (DTC) outcomes is unknown.

METHODS: Multivariate-regression evaluated the association between AJCC7 to AJCC8 stage change and race/ethnicity in patients with DTC in the NCDB. Cox-proportional-regression evaluated whether AJCC7 to AJCC8 stage change affects overall survival (OS) differently based on reported race/ethnicity.

RESULTS: After adjusting for confounders, Hispanics and Asian-Pacific-Islanders (APIs) were 27% and 12% less likely to be down-staged compared to white-non-Hispanics (WNHs) (p < 0.001); black-non-Hispanics (BNHs) had no significant down-staging difference. Down-staged patients had an increased risk of death compared to patients with unchanged staging, regardless of race/ethnicity. However, based on two-way interaction, the magnitude of this negative change on survival from down-staging was only different between WNHs (HR = 2.64) and BNHs (HR = 1.77), (p = 0.04).

CONCLUSIONS: Outcome disparities persist among self-reported racial/ethnic groups with AJCC8. Down-staged patients across all racial/ethnic groups had decreased survival compared to those with unchanged stage, with the least impact in BNHs.

Area of Special Interest

Cancer

Specialty/Research Institute

Oncology

Specialty/Research Institute

Surgery

Specialty/Research Institute

Population Health