Survival Outcomes and Disparities in Surgery Refusal for Papillary Thyroid Cancer.

IF 1.6 4区 医学 Q4 ONCOLOGY
Jade C Bowers, Bansi P Savaliya, Swathi R Raikot, Syeda Hoorulain Ahmed, Ramin Shekouhi, Reed Popp, Kyle Popp, Kulkaew B Sukniam, Gabrielle Kowkabany, Paola Berrios Jimenez, Fatima Mubarak, Esinam P Ekpeh, Shivam Bansal, Seema Sharan, Harsheen K Manaise, Emmanuel M Gabriel
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引用次数: 0

Abstract

Background/aim: Surgery is the cornerstone of treatment for papillary thyroid cancer (PTC), yet some patients refuse surgery, which may impact their survival outcomes. Understanding factors associated with surgery refusal could inform interventions to improve acceptance of recommended care.

Patients and methods: This retrospective cohort study evaluated the impact of surgery refusal on overall survival (OS) and identified associated demographic and clinical factors using data on patients with PTC from the National Cancer Database from 2004 to 2019. OS was analyzed using the Kaplan-Meier method, with survival curves compared using the log-rank test. Patient characteristics were analyzed using Pearson Chi-square tests or Wilcoxon Rank Sum tests.

Results: Of the 201,051 patients with PTC who were advised to undergo surgery, 200,656 (99.8%) underwent surgery, while 395 (0.2%) refused. Patients who refused surgery were older (mean age 55.2 years vs. 48.7 years), more often male (27.8% vs. 22.8%), and represented higher proportions of Black, Asian, Hispanic, lower-income, uninsured, and non-privately insured patients (p<0.001). OS rates were significantly lower in patients who refused surgery, with one-year and five-year survival rates of 87% and 34%, respectively, compared to 96% and 56% for those who underwent surgery.

Conclusion: Surgery refusal in patients with PTC was associated with poorer OS outcomes and was more frequent among older adults, socioeconomically disadvantaged populations, and racial and ethnic minorities. Interventions addressing patient concerns and barriers to surgery are critical to improving treatment acceptance and survival among these groups.

甲状腺乳头状癌拒绝手术的生存结局和差异。
背景/目的:手术是甲状腺乳头状癌(PTC)治疗的基石,但一些患者拒绝手术,这可能会影响他们的生存结果。了解与手术拒绝相关的因素可以告知干预措施,以提高对推荐护理的接受程度。患者和方法:这项回顾性队列研究评估了手术拒绝对总生存期(OS)的影响,并利用2004年至2019年国家癌症数据库中PTC患者的数据确定了相关的人口统计学和临床因素。OS采用Kaplan-Meier法分析,生存曲线采用log-rank检验比较。采用Pearson卡方检验或Wilcoxon秩和检验分析患者特征。结果:在201,051例建议手术治疗的PTC患者中,200,656例(99.8%)接受手术治疗,395例(0.2%)拒绝手术治疗。拒绝手术的患者年龄较大(平均年龄55.2岁对48.7岁),更多为男性(27.8%对22.8%),黑人、亚洲人、西班牙人、低收入、无保险和非私人保险患者的比例较高(结论:PTC患者拒绝手术与较差的OS结果相关,并且在老年人、社会经济弱势人群和种族和少数民族中更为常见)。解决患者担忧和手术障碍的干预措施对于提高这些群体的治疗接受度和生存率至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Anticancer research
Anticancer research 医学-肿瘤学
CiteScore
3.70
自引率
10.00%
发文量
566
审稿时长
2 months
期刊介绍: ANTICANCER RESEARCH is an independent international peer-reviewed journal devoted to the rapid publication of high quality original articles and reviews on all aspects of experimental and clinical oncology. Prompt evaluation of all submitted articles in confidence and rapid publication within 1-2 months of acceptance are guaranteed. ANTICANCER RESEARCH was established in 1981 and is published monthly (bimonthly until the end of 2008). Each annual volume contains twelve issues and index. Each issue may be divided into three parts (A: Reviews, B: Experimental studies, and C: Clinical and Epidemiological studies). Special issues, presenting the proceedings of meetings or groups of papers on topics of significant progress, will also be included in each volume. There is no limitation to the number of pages per issue.
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