We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Decreasing Use of Radioactive Iodine for Low-Risk Thyroid Cancer in California, 1999 to 2015.
- Authors
Park, Ki Wan; Wu, James X; Du, Lin; Leung, Angela M; Yeh, Michael W; Livhits, Masha J
- Abstract
<bold>Context: </bold>Routine radioactive iodine (RAI) ablation for low-risk differentiated thyroid cancer (DTC) is not supported by current practice guidelines.<bold>Objective: </bold>To assess recent stage-specific trends in use of RAI ablation.<bold>Design, Setting, and Patients: </bold>Retrospective study of patients with DTC (1999 to 2015) identified from the California Cancer Registry. Statistical analysis included standardized differences, P values, and multivariable analyses using RAI as the predictor variable.<bold>Main Outcome Measures: </bold>Trends and drivers of RAI ablation for low-risk DTC.<bold>Results: </bold>Of 46,906 patients with DTC who underwent near-total or total thyroidectomy [mean age 48.2 ± 15.5 (standard deviation) years, 77% female), 25,457 (54%) received RAI. The proportion of patients with regional/distant disease who received RAI remained stable at 68%. Use of RAI for patients with localized disease (no extrathyroidal extension, lymph node, or distant metastases) decreased from 55% (1999) to 30% (2015), with the most substantial change occurring in tumors <1 cm (39% to 11%). The rate also decreased for localized tumors between 1 and 2 cm (62% to 34%) and 2 and 4 cm (67% to 49%) and remained stable at 59% for tumors >4 cm. In multivariable analyses, patients with localized disease were less likely to receive RAI if they were >65 years old [odds ratio (OR) 0.77, 95% confidence interval (CI): 0.71 to 0.83], had tumors <1 cm (OR 0.33, 95% CI: 0.31 to 0.35), or were treated in an academic hospital (OR 0.71, 95% CI: 0.67 to 0.75).<bold>Conclusions: </bold>The rate of RAI ablation decreased over time, mainly attributable to decreased use for localized DTCs <2 cm. Many patients with low-risk DTC still receive RAI unnecessarily.
- Subjects
CALIFORNIA; IODINE radioisotopes; COMPARATIVE studies; RESEARCH methodology; MEDICAL cooperation; MULTIVARIATE analysis; RESEARCH; UNNECESSARY surgery; THYROID gland tumors; THYROIDECTOMY; EVALUATION research; TREATMENT effectiveness; ACQUISITION of data; RETROSPECTIVE studies; ABLATION techniques; ODDS ratio; THERAPEUTICS
- Publication
Journal of Clinical Endocrinology & Metabolism, 2017, pN.PAG
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/jc.2017-02269