Impact of the 2015 American thyroid association guidelines on treatment in older adults with low-risk, differentiated thyroid cancer - 20/06/22

Doi : 10.1016/j.amjsurg.2022.01.033

Whitney Sutton ^a, Philip K. Crepeau ^a, Joseph K. Canner ^a, Shkala Karzai ^a, Dorry L. Segev ^a,^b, Aarti Mathur ^a,^⁎
^a Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
^b Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

^∗Corresponding author. FACS Department of Surgery, Johns Hopkins University School of Medicine 600 North Wolfe Street, Blalock 606, Baltimore, MD, 21287, USA.FACS Department of SurgeryJohns Hopkins University School of Medicine600 North Wolfe Street, Blalock 606BaltimoreMD21287USA

Abstract

Background

The impact of the 2015 ATA guidelines on treatment for differentiated thyroid cancer (DTC) in older adults is unclear.

Methods

60,567 adults (age≥18) with low-risk DTC diagnosed between 2010 and 2018 were identified using SEER-21. Annual rates of total thyroidectomy (TT), hemithyroidectomy (HT), and active surveillance (AS) were analyzed using interrupted time series stratified by age: younger adults (18–64), older adults (65–79), and the super-elderly (≥80).

Results

After 2015, annual rates of TT decreased by 2.6% and 1.9% in younger and older adults (p < 0.001), but increased by 4.6% in the super-elderly (p = 0.0126). Annual rates of HT increased by 2.6% and 1.7% in younger and older adults (p < 0.001), but decreased by 3.8% in the super-elderly (p = 0.0029). Older adults and the super-elderly were more likely than younger adults to undergo HT (aOR = 1.1, 95% CI: 1.03–1.2, p = 0.002 and aOR = 1.5, 95% CI: 1.3–1.7, p < 0.001) and AS (aOR = 1.5, 95% CI: 1.4–1.7, p < 0.001 and aOR = 6.5, 95% CI: 5.4–7.7, p < 0.001) when compared to TT following 2015.

Conclusions

Treatment of DTC continues to vary significantly among age groups.

Le texte complet de cet article est disponible en PDF.

Highlights

•	The 2015 ATA guidelines recommend hemithyroidectomy or active surveillance for select patients with low-risk thyroid cancer.
•	Following 2015, adults ≥65 were more likely to undergo hemithyroidectomy and active surveillance compared to adults <65.
•	The annual rate of total thyroidectomy has increased among adults ≥80 since 2015.

Le texte complet de cet article est disponible en PDF.

Keywords : Thyroidectomy, Hemithyroidectomy, Active surveillance, Thyroid cancer, ATA guidelines, Older adults