Guideline Adherence and Practice Patterns in the Management of Medullary Thyroid Cancer.

Autor: Frisco NA; Department of Surgery, Duke University Medical Center, Durham, North Carolina., Gunn AH; Department of Surgery, Duke University Medical Center, Durham, North Carolina., Wang F; Duke University Cancer Institute, Durham, North Carolina; Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina., Stang MT; Department of Surgery, Duke University Medical Center, Durham, North Carolina., Kazaure HS; Department of Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: hadiza.kazaure@duke.edu., Scheri RP; Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2023 Jan; Vol. 281, pp. 214-222. Date of Electronic Publication: 2022 Sep 30.
DOI: 10.1016/j.jss.2022.08.039
Abstrakt: Introduction: Little is known about nationwide practice patterns for the management medullary thyroid cancer (MTC) in relation to the 2015 American Thyroid Association guidelines and their impact on survival.
Methods: Using the Surveillance, Epidemiology, and End Results Program database (2000-2018), MTC treatment patterns were evaluated in terms of adherence to the 2015 American Thyroid Association guidelines across three time periods (2000-2009, 2010-2015, and 2016-2018). Outcomes of interest were guideline concordance, treatment utilization trends, disease-specific survival (DSS), and overall survival (OS).
Results: A total of 3332 patients with MTC were identified. Of which, 53.8%, 33.2%, and 11.4% of patients had localized, regional, and distant disease, respectively. In patients with locoregional disease, the rate of guideline-concordant surgery improved over time from 63.0% in 2000-2009 to 76.0% in 2016-2018 (P < 0.001). Guideline-concordant care was associated with increased OS (HR = 1.85, 95% CI: 1.42-2.43, P < 0.001) in patients with localized disease and increased DSS (HR = 1.65, 95% CI: 1.01-2.54, P < 0.001) and OS (HR = 1.89, 95% CI: 1.35-2.58, P < 0.001) in patients with regional disease. The median OS and DSS in patients with distant disease were 31 and 55 mo, respectively, and the rate of chemotherapy use rose from 21.6% to 39.2% (P = 0.003).
Conclusions: The rate of guideline-concordant surgery for locoregional MTC increased after guideline publication in 2015, with an observed prolongment in OS and DSS. Chemotherapy use among patients with distant disease has increased over time, but their prognosis remains variable.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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