County Median Family Income Is an Independent Prognostic Factor for Stage IV Anaplastic Thyroid Cancer

Abstract

Background/Aim: Advanced anaplastic thyroid cancer (ATC) is a rare, but highly aggressive malignancy, and its prognostic factors need to be further explored. We examined socioeconomic factors' predictive effect for survival performance in stage IV ATC patients. Materials and Methods: Using the Surveillance, Epidemiology, and End Results database, we collected 1,048 cases with stage IV anaplastic thyroid cancer (ATC) from 2004 to 2015. Demographic, clinical, and socioeconomic factors were evaluated using univariate and multivariate analyses. Results: Median family income showed a significant effect on overall survival (OS) and cancer-specific survival (CSS) in univariate analysis. Median family income level was found to be an independent prognostic factor for OS after multivariate adjustment Multivariate analysis for CSS showed similar results. Conclusion: Family income level is an independent prognostic factor for stage IV ATC.Anaplastic thyroid cancer (ATC) is rare, but is one of the most lethal neoplasms in humans (1). Arising in the thyroid follicular epithelium, ATC is composed of undifferentiated cells that lack classic features of the thyroid gland and is, thus, also known as undifferentiated thyroid cancer (2). While it comprises of just 2% of all thyroid cancers, it accounts for up to 50% of mortality associated with thyroid cancer (3). Death often follows only a few months following diagnosis -median survival is 5 months (4), and less than 20% of patients survive for more than one year (5). This grim prognosis of ACT is likely due to the combination of occult symptoms, difficult diagnosis, and poor response to therapy (6, 7).Considering the exceptionally aggressive nature of ATC, it is essential to identify its prognostic factors. Previous studies have confirmed that clinical factors including tumor size, presence of acute symptoms, extent of disease, leukocytosis, and treatment type impact survival (8-14). Recent studies have suggested that socioeconomic factors (SEF); such as marital status, insurance type, regional prosperity and educational attainment may also be important to consider as part of the prognosis of cancer disease (15)(16)(17)(18)(19)(20). Studies on the importance of SEF in thyroid cancer, however, have so far mainly addressed well differentiated thyroid cancers rather than ATC (21)(22)(23)(24).In this study, we examined the impact of several SEFs, as well as traditional clinical factors on the survival of patients with stage IV ATC. Our aim was to further understand the role of common SEFs in the prognosis of advanced ATC and find more evidence for improving the quality of public health studies and associated policies. Materials and MethodsData source. All data was extracted from the 2017 Surveillance, Epidemiology, and the End Results (SEER) database of the National Cancer Institute using the SEER*Stat 8.3.5 software.Since 1973, the SEER program has published epidemiological information on cancer statistics in the United States, covering approximately 28% of the population (25). This ...

The association of low socioeconomic status with advanced stage thyroid cancer

“… 18 , 22 , 23 The overall, as well as specific cancer survival, were confirmed to be favourable in married patients. 17 Even though our study did not show any significant association with marital status, it was observed that patients who are married present with early stages frequently than the others. Multiple hypotheses have been proposed in other studies explaining the positive association of being married with a better survival rate.…”

“… 15 , 16 It has also been associated with worse prognosis and outcome even after adjusting for the cancer stage. 17 , 18 , 19 However, it is worth mentioning that all those studies were conducted in non-funded hospital systems. In our study, no association between monthly income and thyroid cancer stage is found.…”

Association of marital status with cardiovascular outcome in patients with breast cancer

“…We further quantitatively evaluated the impact of different marital status on cardiovascular death in breast cancer patients. Categorical variables included marital status (married and unmarried), age at diagnosis (25-60 and >60 years) (13), race (white, black and other), income (low and high) (14), grade (low and high), ER status (positive and negative), PR status (positive and negative), HER2 status (positive and negative), AJCC stage (I, II, III and IV), surgery (yes and no evidence), chemotherapy (yes and no evidence) and radiotherapy (yes and no evidence). As for the income, low household income represented the worst 50% among all breast cancer patients, and high household income represented the best 50% among all breast cancer patients (14).…”

“…Categorical variables included marital status (married and unmarried), age at diagnosis (25-60 and >60 years) (13), race (white, black and other), income (low and high) (14), grade (low and high), ER status (positive and negative), PR status (positive and negative), HER2 status (positive and negative), AJCC stage (I, II, III and IV), surgery (yes and no evidence), chemotherapy (yes and no evidence) and radiotherapy (yes and no evidence). As for the income, low household income represented the worst 50% among all breast cancer patients, and high household income represented the best 50% among all breast cancer patients (14). Low grade included well differentiated (Grade I) and moderately differentiated (Grade II), while high grade included poorly differentiated (Grade III) and undifferentiated (Grade IV).…”

Socioeconomic factors are associated with the prognosis of Thyroid Cancer

“…Previous studies demonstrated that multiple socioeconomic factors might influence the treatment selection and further prognosis of thyroid cancer, such as insurance status, marital status, living area, etc. [4][5][6][7][8][9][10][11][12]. However, all the above studies focused on either a sole socioeconomic factor or a sole histology subtype.…”