Disparities in Racial, Ethnic Outcomes in Differentiated Thyroid Cancer Remain in the AJCC Staging System

After careful consideration, the Endocrine Society canceled its annual meeting (ENDO 2020), which was set to take place in San Francisco, California, from March 28 to 31, 2020, because of concerns regarding coronavirus disease 2019 (COVID-19). Research findings that were scheduled to be presented at the meeting have been published in a supplemental issue of the Journal of the Endocrine Society. The society is hosting ENDO Online, a complimentary virtual event featuring on-demand and live programming, from June 8 to 22, 2020, to provide a platform for continued learning and research exhibition. For more information, visit the Endocrine Society’s website.

The 8th edition of the American Joint Committee on Cancer staging system (AJCC8) does not address current disparities in racial and ethnic outcomes in differentiated thyroid cancer, according to study findings intended to be presented at the annual meeting of the Endocrine Society (ENDO 2020).

Researchers of previous studies have shown there are disparities in racial and ethnic outcomes among patients with differentiated thyroid cancer. However, it is unknown whether the updated AJCC8 has any effect on these disparities.

In this study, researchers used the National Cancer Database to identify patients with differentiated thyroid cancer with sufficient tumor and survival data between 2004 and 2013 and compared criteria between the 7th edition of the AJCC staging system (AJCC7) and AJCC8. The association between AJCC7 to AJCC8 staging change and race/ethnicity was evaluated using multivariable logistic regression, and the association between AJCC7 to AJCC8 staging change and overall survival was evaluated using Cox proportional hazards models.

A total of 33,323 patients were included in the study, 76.7% of whom were white, 7.6% black, 6.7% Hispanic, 5.4% Asian or Pacific Islander, and 3.6% Native American or other.

Patients downstaged from AJCC7 to AJCC8 had an increased risk for death compared with patients with unchanged staging regardless of race and ethnicity. Hispanics and Asians/Pacific Islanders were 27% and 12% less likely to be AJCC7 to AJCC8 downstaged than white patients (odds ratios [ORs], 0.73 [95% CI, 0.66-0.81] and 0.88 [95% CI, 0.79-0.99], respectively). There was no significant downstaging difference between black and white patients (OR, 0.99; 95% CI, 0.90-1.09; P =.79). However, based on 2-way interaction, there was a difference observed in the magnitude of negative change in survival from downstaging between white and black patients (hazard ratios, 2.64 vs 1.77, respectively; P =.04).

The researchers concluded that disparities in racial and ethnic outcomes among patients with differentiated thyroid cancer continue to persist in AJCC8 and that these disparities should be considered when using the new AJCC8 to counsel patients about disease prognosis.

Reference

Santamaria-Barria JA, Graff-Baker AN, Chang S-C, et al. The impact from AJCC 8th edition staging system on thyroid cancer outcomes by race and ethnicity. J Endocr Soc. 2020;4(suppl 1):SUN-426.

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