Patterns in the Reporting of Aggressive Histologic Subtypes in Papillary Thyroid Cancer.

Area of Science:

• Oncology
• Pathology
• Epidemiology

Background:

• Papillary thyroid cancer (PTC) has aggressive subtypes like tall cell, columnar, and diffuse sclerosing.
• These aggressive subtypes (aPTC) are increasing in incidence but show wide reporting variations.
• Understanding reporting factors and outcomes for aPTC compared to classic PTC (cPTC) is crucial.

Purpose of the Study:

• To identify and compare factors associated with reporting aggressive PTC subtypes (aPTC) versus classic PTC (cPTC).
• To secondarily investigate differences in patient outcomes between aPTC and cPTC.

Main Methods:

• Utilized the National Cancer Database (2004-2017) to identify cPTC and aPTC cases.
• Analyzed patient demographics, facility characteristics, and clinicopathologic variables.
• Performed survival analysis to compare outcomes and identified predictors of aPTC reporting.

Main Results:

• Academic facilities were more likely to report aPTC than other facility types (1.4-2.0 times).
• The Middle Atlantic region reported more aPTC cases compared to other regions, despite regional variations in total facility numbers.
• Aggressive PTC subtypes demonstrated higher rates of aggressive features and worse 5-year overall survival (90.5%) compared to classic PTC (94.5%).

Conclusions:

• Aggressive PTC subtypes are associated with significantly worse patient outcomes.
• Reporting of aPTC is more prevalent in academic facilities and the Middle Atlantic region.
• Findings suggest a need to explore environmental/geographic factors and improve diagnostic awareness for aPTC.