Comparison of Radioiodine Utilization in Adolescent and Young Adult and Older Thyroid Cancer Patients |
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| Institution: | 1. Endocrine Section, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.;2. Puerto Rico Clinical and Translational Research Consortium, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.;1. Diskapi Yildirim Beyazit Training and Research Hospital, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey;2. Ankara University, School of Medicine, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey;3. Diskapi Yildirim Beyazit Training and Research Hospital, Department of Biochemistry, Ankara, Turkey;4. Hacettepe University, School of Medicine (Kastamonu), Ankara-Turkey.;1. Pharmacogenetics Unit; UGC Provincial de Farmacia de Granada; Instituto de Investigación Biosanitaria de Granada; Complejo Hospitalario de Granada, Granada, Spain;2. Environmental Protection Department; Estación Experimental del Zaidín (EEZ); Spanish National Research Council (CSIC); Granada, Spain;;3. Instituto de Biología Molecular y Celular, Universidad Miguel Hernández, Elche, Alicante, Spain;4. UGC Anatomía Patológica, Complejo Hospitalario de Granada, Granada, Spain;5. Servicio de Endocrinología, Complejo Hospitalario de Granada, Granada, Spain;6. Servicio de Medicina Nuclear, Complejo Hospitalario de Granada, Granada, Spain.;1. Department of Otolaryngology-Head & Neck Surgery, McGill Thyroid Cancer Center, Montreal, Canada;2. Department of Medicine, Division of Endocrinology and Metabolism, Jewish General Hospital, Montreal, Canadas;3. Department of Medicine, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada;4. Department of Pathology, McGill Thyroid Cancer Center, Montreal, Canada. |
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| Abstract: | ObjectiveDifferentiated thyroid cancer (DTC) is 1 of the most common cancers in adolescents and young adults (AYA, ages 15-39). Although most AYAs with DTC are considered low risk compared to older patients, there are no specific postoperative radioiodine (RAI) treatment recommendations despite the potential adverse effects specific to this age group, namely secondary malignancies and fertility difficulties. This study compares factors influencing RAI utilization in AYA and older patients.MethodsA total of 5,687 primary DTC patients were identified from the SEER (Surveillance, Epidemiology, and End Results) database between January 1, 2004 and January 31, 2009. The 2009 American Thyroid Association (ATA) guidelines were used to classify patients as low (LR) or intermediate/high risk (IHR) based on tumor characteristics. Multivariate logistic regression analysis was performed.ResultsOverall, 56.9% of AYA (n = 1,963) patients received postoperative RAI compared to 52.2% of older (n = 3,724) patients (odds ratio OR]: 1.21, 95% confidence interval CI]: 1.09-1.35, P = .001). For AYA patients, having a total thyroidectomy (TTx) (OR: 3.53, 95% CI: 2.7-4.61, P < .001) predicted RAI in a multivariate model whereas LR status (OR: 0.52, 95% CI: 0.43-0.63, P < .001) and northeast residence (OR: 0.39, 95% CI: 0.29-0.52, P < .001) decreased the probability. All 3 factors similarly affected older patients in addition to an increased likelihood after lymph node (LN) dissection. Additionally, after selecting for TTx (n = 1,077), no factor influenced the use of RAI for AYA patients, whereas LR (OR: 0.30, 95% CI: 0.21-0.43, P < .001) and northeast residence (OR: 0.39, 95% CI: 0.19-0.79, P = .008) were associated with decreased RAI use in older patients.ConclusionDespite their excellent prognosis, AYA thyroid cancer patients are more likely to receive postoperative RAI compared to older patients. Increased awareness of the unique survivorship implications for AYA patients will be an important aspect to address going forward. (Endocr Pract. 2014;20:405-411) |
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