Decreasing use of radioactive iodine for low risk thyroid cancer in California, 1999-2015.
J Clin Endocrinol Metab. 2017 Dec 15;:
Authors: Park KW, Wu JX, Du L, Leung AM, Yeh MW, Livhits MJ
Abstract
Context: Routine radioactive iodine (RAI) ablation for low-risk differentiated thyroid cancer (DTC) is not supported by current practice guidelines.
Objective: To assess recent stage-specific trends in utilization of RAI ablation.
Design, Setting and Patients: Retrospective study of patients with DTC (1999-2015) identified from the California Cancer Registry. Statistical analysis included standardized differences, p-values, and multivariable analyses using RAI as the predictor variable.
Main Outcome Measures: Trends and drivers of RAI ablation for low-risk DTC.
Results: Of 46,906 patients with DTC who underwent near-total or total thyroidectomy (mean age 48.2±15.5 [SD] years, 77% female), 25,457 (54%) received RAI. The proportion of patients with regional/distant disease who received RAI remained stable at 68%. Utilization of RAI for patients with localized disease (no extrathyroidal extension, lymph node or distant metastases) decreased from 55% (1999) to 30% (2015), with the most significant change occurring in tumors <1 cm (39% to 11%). The rate also decreased for localized tumors between 1-2 cm (62% to 34%) and 2-4 cm (67% to 49%), and remained stable at 59% for tumors >4 cm. In multivariable analysis, patients with localized disease were less likely to receive RAI if they were >65 years old (OR 0.77, 95% CI: 0.71-0.83), had tumors <1 cm (OR 0.33, 95% CI: 0.31-0.35), or were treated in an academic hospital (OR 0.71, 95% CI: 0.67-0.75).
Conclusions: The rate of RAI ablation has decreased over time, mainly attributable to decreased use for localized DTCs < 2 cm. Many patients with low-risk DTC still receive RAI unnecessarily.
PMID: 29267880 [PubMed - as supplied by publisher]
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