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Adherence to Guidelines and Survival Impact of Radioactive Iodine in Oncocytic Thyroid Carcinoma: A National Cancer
Tony Boualoy1, Alexandra H Helbing1, Samantha Sherman1
1Department of Surgery, Parkview Health, Fort Wayne, Indiana.
Introduction:
The role of postoperative radioactive iodine (RAI) in oncocytic thyroid carcinoma (OTC) remains uncertain. While contemporary guidelines recommend a risk-stratified approach to RAI, its real-world adherence and survival impact are not well-defined. This study evaluated adherence to National Comprehensive Cancer Network criteria for RAI administration and its associated outcomes.
Methods:
A retrospective cohort analysis of the National Cancer Database (NCDB) identified adults with OTC who underwent thyroidectomy from 2000 to 2024. Patients were stratified by National Comprehensive Cancer Network risk categories, and RAI utilization, predictors of treatment, and survival outcomes were analyzed using multivariable logistic and Cox regression.
Results:
Among 12,719 patients, 22.9% were high-risk and 4.8% low-risk. Despite guideline recommendations, 32.4% of high-risk patients did not receive postoperative RAI, while 41% of low-risk patients received RAI. Underuse among high-risk patients was associated with T1 stage, M0 status, negative margins, lobectomy, Hispanic ethnicity, and older age. In high-risk disease, RAI was associated with lower mortality (hazard ratio: 0.78, 95% confidence interval: 0.67 - 0.92). No survival benefit was observed for low-risk patients (hazard ratio: 0.62, 95% confidence interval: 0.37 - 1.03).
Conclusions:
RAI use in OTC remains inconsistent, with underuse in high-risk and overuse in low-risk disease. These findings suggest that the benefit of RAI is largely confined to patients with high-risk features and emphasize the need for improved implementation and stronger evidence to guide management in this distinct thyroid cancer subtype.
