Significant racial differences in the incidence and behavior of the follicular variant of papillary thyroid carcinoma

Abstract

Background Increased detection of papillary thyroid cancer (PTC) has led to overtreatment of the largely indolent follicular variant (fvPTC). To guide management of non‐aggressive lesions, we investigated whether race predicts PTC variant and tumor behavior. Methods Analysis of 258 973 patients from the National Cancer Database diagnosed with PTC in 2004‐2014. Clinical and tumor information was compared by race. Multivariate logistic regression was used to predict fvPTC, extrathyroidal extension (ETE), and lymph node metastasis (LNM) of fvPTC. Results Blacks had the highest fvPTC rate (40% vs white 30%, Hispanic 26%, Asian 25%, P < .001). Blacks had higher odds of fvPTC (aOR = 1.33, 95% CI: 1.28‐1.37) and lower odds of ETE than whites (aOR = 0.90, 95% CI: 0.82‐0.99) (P < .001). Hispanics and Asians had lower odds of fvPTC (aOR = 0.89, 95% CI: 0.86‐0.92 and aOR = 0.81, 95% CI: 0.79‐0.84) and higher odds of LNM and ETE than whites (P < .001). Conclusions Racial disparities in fvPTC incidence and behavior should be considered to optimize diagnosis and treatment planning.

Genetic variation in POT1 and risk of thyroid subsequent malignant neoplasm: A report from the Childhood Cancer Survivor Study

“…For example, all risk allele carriers excluded from CEU-only analysis were of primarily African ancestry (one homozygous individual with thyroid SMN and 12 carriers without thyroid SMN). Although thyroid cancer incidence is highest among individuals of European ancestry, [47] African ancestry confers a higher risk for the follicular variant of papillary thyroid cancer, [48] which was the SMN subtype observed in the survivor with thyroid SMN that was homozygous for the rs58722976 risk allele.…”

Thyroid nodules of indeterminate cytology in Hispanic/Latinx patients

“…The incidence and outcome of differentiated thyroid carcinoma (DTC) differ between racial and ethnic groups 1–7 . DTC is the most common malignant endocrine tumor, with an increasing incidence of about 47 200 new cases per year 8 .…”

“…Blacks with classic papillary thyroid carcinoma (cPTC) or follicular‐variant PTC (fvPTC) are less likely to have lymph node involvement, but more likely to have distant metastases (OR = 1.72) 4 . Blacks have the highest proportion of fvPTC (40% vs. 30% in whites and 26% in Hispanic/Latinxs) 5 and reduced survival even for papillary thyroid microcarcinoma (PTMC) (OR = 2.59) 6 . Despite the fact that Hispanic/Latinx patients are more likely than whites to present with locoregional disease (OR = 1.59), they have higher overall and disease‐specific survival than whites or blacks with metastatic DTC 3 …”

“…The incidence and outcome of differentiated thyroid carcinoma (DTC) differ between racial and ethnic groups. [1][2][3][4][5][6][7] DTC is the most common malignant endocrine tumor, with an increasing incidence of about 47 200 new cases per year. 8 Pertinent to our study, the rate of increase is about 2-fold faster in blacks (12.8%) and Hispanics/ Latinxs (11.2%) than it is in whites (7.6%).…”

“…in whites and 26% in Hispanic/Latinxs) 5 and reduced survival even for papillary thyroid microcarcinoma (PTMC) (OR = 2.59). 6 Despite the fact that Hispanic/Latinx patients are more likely than whites to present with locoregional disease (OR = 1.59), they have higher overall and disease-specific survival than whites or blacks with metastatic DTC.…”