Racial disparities in thyroid cancer outcomes: A systematic review

Polina Zmijewski; Chibueze Nwaiwu; Hayato Nakanishi; Soroush Farsi; Jessica Fazendin; Brenessa Lindeman; Herbert Chen; Andrea Gillis

doi:10.1016/j.amjsurg.2024.115991

Racial disparities in thyroid cancer outcomes: A systematic review

Am J Surg. 2024 Sep 28:115991. doi: 10.1016/j.amjsurg.2024.115991. Online ahead of print.

Authors

Polina Zmijewski¹, Chibueze Nwaiwu², Hayato Nakanishi³, Soroush Farsi⁴, Jessica Fazendin¹, Brenessa Lindeman¹, Herbert Chen¹, Andrea Gillis⁵

Affiliations

¹ Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
² Department of Surgery, Brown University/ Rhode Island Hospital, Providence, RI, USA.
³ St George's University of London, London, SW17 0RE, UK; University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus.
⁴ Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA.
⁵ Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: agillis@uabmc.edu.

PMID: 39395884
DOI: 10.1016/j.amjsurg.2024.115991

Abstract

Introduction: Racial disparities in surgical outcomes are well described, but a paucity of literature exists examining trends in outcomes of thyroid cancer. We performed a systematic review of studies on thyroid cancer outcomes to better delineate the impact of race.

Methods: A comprehensive search strategy was performed in several academic databases for articles on thyroid cancer and surgical outcomes in accordance with PRISMA guidelines. A total of 1771 abstracts were reviewed. Abstracts were screened by two independent reviewers with disagreements resolved by a third. Studies that were based in the United States, included single center, unique data, focused on outcomes of differentiated thyroid cancer, were performed on adults >18 years old, and reported race in their results were included. Chi square statistics with Yates correction were calculated on the compiled data. The protocol was registered on PROSPERO (CRD42022300021).

Results: Twelve studies met inclusion criteria with data on 7,221patients. Among the included studies, our study consists of 67 % White patients, 22 % Black patients, 7 % Hispanic patients, and 3 % Asian patients. Extrathyroidal extension was observed in 8.4 % (n = 13) of White patients. In comparison to White patients, Black (18.4 %, n = 21, p = 0.024) and Hispanic patients (28.3 %, n = 30, p < 0.001) had a higher incidence of extrathyroidal extension, while a similar incidence was observed in Asian patients (14.0 %, n = 8, p = 0.336). Compared to White patients (22.2 %, n = 34), Black (12.4 %, n = 13, p = 0.065), Hispanic (16.0 %, n = 15, p = 0.301), and Asian (18.4 %, n = 9, p = 0.709) patients had a similar incidence of T1a stage. White patients had 10.1 % (n = 54) recurrence rates, and Black (13.5 %, n = 7, p = 0.595), Hispanic (10.5 %, n = 2, p = 1.000), and Asian (11.1 %, n = 3, p = 1.000) patients had similar recurrence rates.

Conclusions: Race is seldom reported in outcomes on studies of thyroid cancer. From our analysis we conclude that non-White patients may have a higher risk of more advanced local disease at presentation. More data with granular detail on race is necessary to better understand racial disparities in thyroid cancer outcomes and how to alleviate them.