A National Cancer Data Base Report on 53,856 Cases of Thyroid Carcinoma Treated in the US, 1985-1995

BACKGROUND. The National Cancer Data Base (NCDB) represents a national elec tronic registry system now capturing nearly 60% of incident cancers in the U.S. In combination with other Commission on Cancer programs, the NCDB offe rs a working example of voluntary, accurate, cost-effective "outcomes manag ement" on a both a local and national scale. In addition, it is of particul ar value in capturing clinical information concerning rare cancers, such as those of the thyroid. METHODS. For the accession years 1985-1995, NCDB captured demographic, patt erns-of-care, stage, treatment, and outcome information for a convenience s ample of 53,856 thyroid carcinoma cases (1% of total NCDB cases). This arti cle focuses on overall 10-year relative survival and American Joint Committ ee on Cancer (AJCC) (3rd/4th edition) stage-stratified 5-year relative surv ival for each histologic type of thyroid carcinoma. Care patterns also are discussed. RESULTS. The 10-year overall relative survival rates for U.S. patients with papillary, follicular, Hurthle cell, medullary, and undifferentiated/anapl astic carcinoma was 93%, 85%, 76%, 75%, and 14%, respectively. For papillar y and follicular neoplasms, current AJCC staging failed to discriminate bet ween patients with Stage I and II disease at 5 years. Total thyroidectomy /- lymph node sampling/dissection represented the dominant method of surgic al treatment rendered to patients with papillary and follicular neoplasms. Approximately 38% of such patients receive adjuvant iodine-131 ablation/the rapy. At 5 years, variation in surgical treatment (i.e., lobectomy vs. more extensive surgery) failed to translate into compelling differences in surv ival for any subgroup with papillary or follicular carcinoma, but longer fo llow-up is required to evaluate this. NCDB data appeared to validate the AM ES prognostic system, as applied to papillary cases. Younger age appeared t o influence prognosis favorably for all thyroid neoplasms, including medull ary and undifferentiated/anaplastic carcinoma NCDB data also revealed that unusual patients diagnosed with undifferentiated/anaplastic carcinoma befor e age of 45 years have better survival. CONCLUSIONS. The NCDB system permits analysis of care patterns and survival for large numbers of contemporaneous U.S. patients with relatively rare ne oplasms, such as thyroid carcinoma. In this context, it represents an unsur passed clinical tool for analyzing care, evaluating prognostic models, gene rating new hypotheses, and overcoming the volume-related drawbacks inherent in the study of such neoplasms. [See editorial on pages 2434-6, this issue .] Cancer 1998;83:2638-48. (C) 1998 American Cancer Society.