J. Alkhatib1, R. Wang1, A. Bonner1, B. Lindeman1, A. Gillis1, J. Fazendin1, H. Chen1 1University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA
Introduction: Hürthle cell carcinoma, a rare subtype of follicular thyroid cancer, is often locally invasive and metastasizes to distant organ. Total thyroidectomy at an early stage is associated with increased rates of recurrence-free survival. Our study aimed to determine the risk factors associated with advanced Hürthle cell carcinomas and the pattern of surgical management using a large national patient population.
Methods: The National Cancer Database was analyzed to identify Hu?rthle cell carcinoma patients from 2004 to 2020. Socioeconomic variables, including race, ethnicity, insurance status, income level, comorbidities, and distance to clinic, were explored in association with disease severity as represented by tumor stage at diagnosis. Facility volume and surgical operation were also assessed in association with tumor stage at diagnosis. All associations were assessed using univariate and multivariate binary logistic regression.
Results: Of 12,438 patients included, 6,430 exhibited early disease (stage 1 or 2), while 2,392 had advanced disease (stage 3 or 4). The early disease group had more female (73.2%vs.53.3%, P<.001), non-white (12.1%vs.10.4%, P=.019), Hispanic (6.1%vs.5.2%, P=.002) patients and had more patients with no comorbidities (85%vs.75.5%, P<.001) and private insurance (69.2%vs.44.1%, P<.001). For multivariate analysis, male (OR=2.310, P<.001), Black (OR=1.303, P=.017), and older (OR=1.081, P<.001) patients were independently associated with advanced stage Hürthle cell carcinoma. Private insurance was associated with lower tumor stage (OR=0.505, P<.001), while government insurance had higher tumor stage cases (OR=0.389, P<.001). Lower income levels and the presence of comorbidities were initially associated with a higher likelihood of developing an advanced stage of disease in univariate analysis; however, these associations did not retain statistical significance after conducting multivariate regression analysis. Patients who lived further from a high-volume thyroid cancer center presented with more advanced disease (OR=1.161, P=.023). Patients who were treated at high-volume centers were more likely to have the appropriate surgical management (total thyroidectomy) compared to those treated at low volume centers (r =-0.055, P< .001).
Conclusion: Socioeconomic characteristics were associated with advanced stage of Hürthle cell carcinoma. Significant disparities exist in management of Hürthle cell carcinomas. Early identification of risk factors and improving access to surgical care are warranted among patients with Hürthle cell carcinomas.