Facility type and late-stage Thyroid Hürthle Cell Adenocarcinoma: A NCDB Review.

Abstract

e18074 Background: Hürthle cell adenocarcinoma, or oxyphilic adenocarcinoma, is a rare and invasive cancer accounting for 3-4% of all thyroid malignancies. Surgical removal is the most common treatment. Survival differences based on treatment facility have been identified in other cancers, but this has not yet been studied in Hürthle cell adenocarcinoma. This study utilizes the National Cancer Database (NCDB) to investigate facility survival differences. Methods: Using the NCDB, 2,900 patients with stage III or IV oxyphilic adenocarcinoma of the thyroid were identified with ICD-O-3 histology code 8290/3 and primary site C739 between years 2004 and 2016. Facility types included community cancer, comprehensive community cancer, academic/research, and integrated network cancer programs. Between-facility type survival differences were estimated by the Kaplan-Meier method and associated log-rank tests. Descriptive statistics of race, sex, stage, facility location, urban/rural 2013, primary payer, median income quartile, and Charlson-Deyo score were used. All analysis was conducted using SPSS statistical software version 27. Results: Survival data was available for 2,017 stage III patients and 644 stage IV patients. In stage III, survival was lower in community programs when compared to academic/research (p = .011) and integrated network programs (p = .017). In stage IV, survival was also lower in community programs when compared to academic/research (p = .007) and integrated network programs (p = .011). No significant difference was seen within other comparisons. In both stages, the highest percentage of patients were white, had a Charlson-Deyo score of 0, and were treated in an urban metro area. Sex and facility location were variable among all stages and facilities. In stage III, private insurance was most common overall and for academic/research programs, but Medicare was the majority for other facility types. In stage IV, Medicare was most common overall and for each facility. The median income quartile was > $63,000 across all facility types for stage III and overall for stage IV, although stage IV treated in community and integrated network programs were most commonly between $48,000-$62,999. Conclusions: Patients with late-stage Hürthle cell adenocarcinoma have worse survival when treated in a community program than other facility types. Most demographics were consistent across stage and facility type, except for sex, primary insurance, median income, and facility location. This data contributes to a developing understanding of differences in cancer survival.[Table: see text]