Abstract
Background
Secondary thyroid cancer is believed to lead to a more aggressive clinical course than primary thyroid cancer. We aim to examine the difference between primary and secondary thyroid cancer in terms of patient characteristics and perioperative outcomes at the national level.
Methods
A cross-sectional study utilizing the Nationwide Inpatient Sample database for 2003–2010 was merged with County Health Rankings Data. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to identify adult patients with thyroid cancer.
Results
A total of 21,581 discharge records were included. Overall, 16,625 (77.0 %) patients had primary cancer, while the rest (23.0 %) had secondary cancer. Younger (<45 years) and older (>65 years) patients, males, and those of White or Hispanic background were more likely to have secondary cancers (p < 0.05 each). The prevalence of secondary cancer was higher in communities of low health risk (24.0 % vs. 21.1 %; p < 0.024). Secondary cancer was more likely to be managed by total thyroidectomy (odds ratio [OR] 2.40, 95 % CI 2.12–2.73) and to require additional radical neck dissection (OR 12.51, 95 % CI 10.98–14.25). Patients with secondary thyroid cancers were at higher risk of postoperative complications (p < 0.01 each). The cost of secondary cancer management was significantly higher than primary cancer (US$12,449.00 ± 302.07 vs. US$7848.12 ± 149.05; p < 0.001). However, compared with intermediate-volume surgeons, the complication risk was lower for high-volume (OR 0.47, 95 % CI 0.24–0.92; p = 0.026).
Conclusions
Secondary thyroid cancer is associated with a higher risk of perioperative complications and higher cost and distinct demographic profile. Patients managed by higher-volume surgeons were less likely to experience disadvantageous outcomes.
Similar content being viewed by others
References
National Cancer Institute. The surveillance, epidemiology, and end results program. Updated 2014. http://seer.cancer.gov/.
Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence of thyroid cancer: Update on epidemiology and risk factors. J Cancer Epidemiol. 2013;2013:965212.
Goldfarb M, Freyer DR. Comparison of secondary and primary thyroid cancer in adolescents and young adults. Cancer. 2014;120(8):1155–61.
Diller L, Chow EJ, Gurney JG, et al. Chronic disease in the childhood cancer survivor study cohort: a review of published findings. J Clin Oncol. 2009;27(14):2339–55.
Nielsen SF, Bojesen SE, Birgens HS, Nordestgaard BG. Risk of thyroid cancer, brain cancer, and non-hodgkin lymphoma after adult leukemia: a nationwide study. Blood. 2011;118(15):4062–69.
Lang BH, Wong IO, Wong KP, Cowling BJ, Wan KY. Risk of second primary malignancy in differentiated thyroid carcinoma treated with radioactive iodine therapy. Surgery. 2012;151(6):844–50.
Lal G, Groff M, Howe JR, Weigel RJ, Sugg SL, Lynch CF. Risk of subsequent primary thyroid cancer after another malignancy: latency trends in a population-based study. Ann Surg Oncol. 2012;19(6):1887–96.
Grundmann RT, Meyer F. Second primary malignancy among cancer survivors - epidemiology, prognosis and clinical relevance. Zentralbl Chir. 2012;137(6):565–74.
Veiga LH, Lubin JH, Anderson H, et al. A pooled analysis of thyroid cancer incidence following radiotherapy for childhood cancer. Radiat Res. 2012;178(4):365–76.
Haddy N, El-Fayech C, Guibout C, et al. Thyroid adenomas after solid cancer in childhood. Int J Radiat Oncol Biol Phys. 2012;84(2):e209–15.
Berrington de Gonzalez A, Gilbert E, Curtis R, et al. Second solid cancers after radiation therapy: a systematic review of the epidemiologic studies of the radiation dose-response relationship. Int J Radiat Oncol Biol Phys. 2013;86(2):224–33.
Oeffinger KC, Baxi SS, Novetsky Friedman D, Moskowitz CS. Solid tumor second primary neoplasms: who is at risk, what can we do? Semin Oncol. 2013;40(6):676–89.
Bhatti P, Veiga LH, Ronckers CM, et al. Risk of second primary thyroid cancer after radiotherapy for a childhood cancer in a large cohort study: an update from the childhood cancer survivor study. Radiat Res. 2010;174(6):741–52.
Chow EJ, Friedman DL, Stovall M, et al. Risk of thyroid dysfunction and subsequent thyroid cancer among survivors of acute lymphoblastic leukemia: a report from the childhood cancer survivor study. Pediatr Blood Cancer. 2009;53(3):432–37.
Ng AK, Kenney LB, Gilbert ES, Travis LB. Secondary malignancies across the age spectrum. Semin Radiat Oncol. 2010;20(1):67–78.
Healthcare Cost and Utilization Project. Overview of national (nationwide) inpatient sample (NIS). Updated 2013. http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed Sept 2013.
Community Health Rankings and Roadmaps. Rankings. Updated 2014. http://www.countyhealthrankings.org/our-approach.
Healthcare Cost and Utilization Project (HCUP). NIS description of data elements. Updated 2008. http://hcup-us.ahrq.gov/db/nation/nis/nisdde.jsp.
Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130–39.
Kandil E, Noureldine SI, Abbas A, Tufano RP. The impact of surgical volume on patient outcomes following thyroid surgery. Surgery. 2013;154(6):1346–52; discussion 1352–3.
Li N, Du XL, Reitzel LR, Xu L, Sturgis EM. Impact of enhanced detection on the increase in thyroid cancer incidence in the united states: review of incidence trends by socioeconomic status within the surveillance, epidemiology, and end results registry, 1980–2008. Thyroid. 2013;23(1):103–10.
Torres-Cintron M, Ortiz AP, Ortiz-Ortiz KJ, et al. Using a socioeconomic position index to assess disparities in cancer incidence and mortality, Puerto rico, 1995–2004. Prev Chronic Dis. 2012;9:E15.
Soloway LE, Boscoe FP, Schymura MJ, et al. Thyroid cancer incidence in highly observant jewish neighborhoods in metropolitan New York city. Thyroid. 2011;21(11):1255–61.
Morris LG, Sikora AG, Myssiorek D, DeLacure MD. The basis of racial differences in the incidence of thyroid cancer. Ann Surg Oncol. 2008;15(4):1169–76.
Hauch A, Al-Qurayshi Z, Randolph G, Kandil E. Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons. Ann Surg Oncol. 2014;21(12):3844–52.
Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the united states. N Engl J Med. 2003;349(22):2117–27.
Courcoulas A, Schuchert M, Gatti G, Luketich J. The relationship of surgeon and hospital volume to outcome after gastric bypass surgery in pennsylvania: a 3-year summary. Surgery. 2003;134(4):613–21; discussion 621–3.
Nguyen NT, Paya M, Stevens CM, Mavandadi S, Zainabadi K, Wilson SE. The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg. 2004;240(4):586–93; discussion 593–4.
Ho V, Heslin MJ. Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann Surg. 2003;237(4):509–14.
Casson AG, van Lanschot JJ. Improving outcomes after esophagectomy: the impact of operative volume. J Surg Oncol. 2005;92(3):262–6.
Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg. 1998;228(3):320–30.
Sosa JA, Mehta PJ, Wang TS, Boudourakis L, Roman SA. A population-based study of outcomes from thyroidectomy in aging Americans: at what cost? J Am Coll Surg. 2008;206(3):1097–105.
Loyo M, Tufano RP, Gourin CG. National trends in thyroid surgery and the effect of volume on short-term outcomes. Laryngoscope. 2013;123(8):2056–63.
Gourin CG, Tufano RP, Forastiere AA, Koch WM, Pawlik TM, Bristow RE. Volume-based trends in thyroid surgery. Arch Otolaryngol Head Neck Surg. 2010;136(12):1191–8.
Morris S, Hunter RM, Ramsay AI, et al. Impact of centralising acute stroke services in english metropolitan areas on mortality and length of hospital stay: difference-in-differences analysis. BMJ. 2014;349:g4757.
Hunter RM, Davie C, Rudd A, et al. Impact on clinical and cost outcomes of a centralized approach to acute stroke care in London: a comparative effectiveness before and after model. PLoS One. 2013;8(8):e70420.
Bristow RE, Santillan A, Diaz-Montes TP, et al. Centralization of care for patients with advanced-stage ovarian cancer: a cost-effectiveness analysis. Cancer. 2007;109(8):1513–22.
Shaw JJ, Santry HP, Shah SA. Specialization and utilization after hepatectomy in academic medical centers. J Surg Res. 2013;185(1):433–40.
Stitzenberg KB, Meropol NJ. Trends in centralization of cancer surgery. Ann Surg Oncol. 2010;17(11):2824–31.
Ravi P, Bianchi M, Hansen J, et al. Benefit in regionalisation of care for patients treated with radical cystectomy: a nationwide inpatient sample analysis. BJU Int. 2014;113(5):733–40.
Stitzenberg KB, Sigurdson ER, Egleston BL, Starkey RB, Meropol NJ. Centralization of cancer surgery: implications for patient access to optimal care. J Clin Oncol. 2009;27(28):4671–8.
Acknowledgment
No form of financial or material-based support was received for this study.
Disclosures
Zaid Al-Qurayshi, Hossam Mohamed, Parisha Bhatia, Sudesh Srivastav, Rizwan Aslam, and Emad Kandil have nothing to disclose.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Al-Qurayshi, Z., Mohamed, H., Bhatia, P. et al. Comparison of Secondary and Primary Thyroid Cancers: Patient Characteristics and Postoperative Outcomes. Ann Surg Oncol 22 (Suppl 3), 691–698 (2015). https://doi.org/10.1245/s10434-015-4800-0
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-015-4800-0