Context Noninvasive encapsulated follicular variant of papillary thyroid cancer (EFVPTC) was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in January 2017. The impact of this nomenclature change at a population level remains unknown. Objective Examine use of NIFTP across different US regions and populations. Design Descriptive epidemiology study using SEER-22 data (2000-2019). Participants Individuals diagnosed with papillary or follicular thyroid cancer (2000-2019), or NIFTP (2017-2019). Main outcome measures Annual incidence rates of thyroid cancer by subtype and NIFTP. Using 2018-2019 data: 1) rates of NIFTP at the 17 SEER-22 sites, and 2) comparison of demographics for patients diagnosed with NIFTP versus papillary and follicular thyroid cancer. Results NIFTP comprised 2.2% and 2.6% of cases in 2018 and 2019, respectively. Between 2018-2019, large heterogeneity was observed in the regional use of NIFTP diagnosis, with site-specific incidence rates between 0.0-6.2% (median 2.8%, IQR 1.3-3.6%). A diagnosis of NIFTP (vs papillary and follicular thyroid cancer) was significantly associated with older age (P=0.012 and P=0.009), Black race (both P<0.001), and non-Hispanic ethnicity (both P<0.001) for 2018 and 2019, respectively. Conclusions Marked variation exists in the use of the NIFTP diagnosis. The recent 2021 coding change that resulted in NIFTP, a tumor with uncertain malignant potential and for which there is no long-term outcome data available, no longer being a reportable diagnosis to SEER will disproportionately affect vulnerable patient groups such as older patients and Black patients, in addition to patients who reside in regions with higher rates of NIFTP diagnoses.
Aims Cardiovascular outcome trials with sodium–glucose cotransporter 2 inhibitors (SGLT‐2is) have documented a positive impact on micro‐ and macrovascular complications of type 2 diabetes (T2D). Most analyses suggest that these benefits are independent of achieving metabolic control. This meta‐regression analysis was undertaken to explore the relationship between metabolic components positively influenced by SGLT‐2is and a reduction in cardiovascular death (CV death) or hospitalization due to heart failure (hHF). Methods and results A database search was conducted using the Cochrane Library to identify relevant studies. Analysis was conducted using CMA and RStudio (2022.07.1) software. The hazard ratios of the individual studies were used to compute the random effects model mean effect size for CV death or hHF, and the prediction interval was used to identify the uncertainty in the summary treatment effect. Heterogeneity was quantified using Q statistics. A pooled population of 46 969 patients from five studies was included for analysis. The Cochrane risk of bias tool was used to assess the quality of the studies. There was a significant 23% reduction in CV deaths or hHFs in the SGLT‐2i arm compared with the placebo arm [hazard ratio (HR): 0.77, 95% confidence interval (CI) 0.70–0.85]. However, the prediction interval (0.57–1.05) and the Q statistics [8.06 > degrees of freedom ( df ) of 4] were indicative of uncertainty in the true effect or heterogeneity. Nearly 50% of the variance of the observed effects were related to the true effects ( I 2 = 50%). Among the moderators selected, a significant correlation of the outcomes was found with the weight variable ( P < 0.01). Weight differential could explain the entire variance in true effect size ( R 2 = 1.00) ruling out any sampling error. Conclusions The results of this meta‐regression analysis suggest that the beneficial effects of SGLT‐2is in reducing CV deaths and hHFs are related to the weight variable.
Background The North American Association of Central Cancer Registries (NAACCR) develops and promotes uniform data standards for cancer registries, such as uniform cancer coding, and is used by all central cancer registries in the United States (US) and Canada, including Surveillance, Epidemiology and End Results (SEER). Effective January 1, 2017, the NAACCR modified its coding scheme and noninvasive encapsulated follicular variant of papillary thyroid cancer (EFVPTC) was reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) to reflect the indolent nature and very low risk of adverse outcomes of this thyroid tumor. The diagnostic use of NIFTP was anticipated to impact tens of thousands of patients in the US. Since NIFTP is no longer considered a cancer, as of January 1, 2021, it was no longer a reportable diagnosis in SEER. However, little is known about how the diagnosis of NIFTP was utilized across different regions and patient populations in the US when it was a reportable diagnosis. Methods Data was extracted from the US SEER-21 cancer registry (2000-2018). The study cohort comprised of individuals diagnosed with papillary or follicular thyroid cancer (2000-2018), or NIFTP (2017-2018). We examined the annual incidence of thyroid cancer by subtypes and NIFTP. Using data for 2018, we determined the rates of NIFTP for each of the 16 sites included in SEER-21. In addition, we compared the demographics of patients diagnosed with NIFTP to that of patients diagnosed with papillary and follicular thyroid cancer using Chi-square test. Results Between 2010 and 2018, we identified a total of 191,107 cases (182,893 PTC, 7,445 FTC, and 769 NIFTP). Incidence of FVPTC sharply declined from 2015 to 2018, with observed increases in NIFTP and encapsulated PTC/ invasive EFVPTC each accounting for 17% and 10% of the decline in FVPTC, respectively. High heterogeneity was observed in the regional incidence of NIFTP in 2018, with incidence rates ranging from 0.0% (Alaska) to 5.8% (Seattle-Puget Sound). Based on 2018 data, a diagnosis of NIFTP (2.2% of total thyroid cancer cases) was significantly associated with female sex (P=0.001), Black race (P<0.001), and non-Hispanic ethnicity (P<0.001) compared to diagnosis of papillary and follicular thyroid cancer. Conclusion There is marked variation in the use of the NIFTP diagnoses. The recent NAACCR coding change that resulted in NIFTP, a tumor with uncertain malignant potential and for which there is no long-term outcome data available, no longer being a reportable diagnosis will disproportionately affect women and Black patients, and patients who reside in regions with higher rates of NIFTP diagnoses. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
Background and aim Cardiovascular outcome trials with sodium–glucose cotransporter 2 inhibitors (SGLT-2is) have documented a positive impact on micro- and macrovascular complications of type 2 diabetes (T2D). Most analyses suggest that these benefits are independent of achieving metabolic control. This meta-regression analysis was undertaken to explore the relationship between metabolic components positively influenced by SGLT-2is and a reduction in cardiovascular death (CV death) or hospitalization due to heart failure (hHF). Materials and methods A database search was conducted using the Cochrane Library to identify relevant studies. Analysis was conducted using CMA and RStudio (2022.07.1) software. The hazard ratios of the individual studies were used to compute the random effects model mean effect size for CV death or hHF, and the prediction interval was used to identify the uncertainty in the summary treatment effect. Heterogeneity was quantified using Q statistics. Results A pooled population of 46,969 patients from five studies was included for analysis. The Cochrane risk of bias tool was used to assess the quality of the studies. There was a significant 23% reduction in CV deaths or hHFs in the SGLT-2i arm compared to the placebo arm (hazard ratio (HR): 0.77, 95% confidence interval (CI) 0.70–0.85). However, the prediction interval (0.57–1.05) and the Q statistic (8.06 > degrees of freedom (df) of 4) were indicative of uncertainty in the true effect or heterogeneity. Among the moderators selected, a significant correlation of the outcomes was found with the weight variable (p < 0.01). Conclusion The results of this meta-regression analysis suggest that the beneficial effects of SGLT-2is in reducing CV deaths and hHFs are related to the weight variable.
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