BACKGROUND
Thyroid cancer is common, especially in women. Fortunately, many/most of these thyroid cancers are low risk and the prognosis is excellent due to very effective treatments. A variety of studies have shown that thyroid cancer is more common in patients that identify as non- Hispanic Whites and Asian American and/or Pacific Islander (AAPI) as compared to other ethnicities. AAPI patients are a diverse group of people. Despite this, AAPI patients have been grouped together commonly for research and population studies.

This study subdivides AAPI patients into various ethnicities to see if there is a difference in the stage at presentation or treatment responses of thyroid cancer when comparing different ethnicities.

THE FULL ARTICLE TITLE
Zhao HH and Wilhelm SM. Exploring ethnic diversity and clinical outcome variabilities in well-differentiated thyroid cancer among the Asian population. Surgery 2025;177:108827; doi: 10.1016/j.surg.2024.05.049. PMID: 39384480.

SUMMARY OF THE STUDY
In the National Cancer Database, patients who listed their race as Asian American and/or Pacific Islander (AAPI) were analyzed for their thyroid cancer responses to therapy. From 2004 to 2019, patients who were 18 years and older were analyzed. The patient was not included if he/she did not provide their race/ ethnicity. The AAPI patients were subdivided into the following 12 Asian ethnicities: Chinese, Japanese, Filipino, Korean, Vietnamese, Laotian, Hmong, Kampuchean, Thai, Asian Indian, Pakistani, and Pacific Islander. Of the total 364,604 patients, the largest subgroup was Chinese (3851 patients), followed by Filipino (3466) and Korean (1567). Hmong patients was the smallest group with 50 patients.

There were differences found in the surgical specimen pathology and death rates when AAPI patients were compared to patients of non-Hispanic White race/ ethnicity. About 73.7%- 86% of the patients studied were female. Japanese patients were the oldest (average age 54), and Asian Indian and Pakistani patients were the youngest (average age 41). Chinese patients were the healthiest with the least medical problems outside of the thyroid cancer, while Pakistani patients had the most medical problems outside of the thyroid cancer. Asian Indian patients had the highest socioeconomic status, and Thai patients had the highest rate of being uninsured. Although they received the same surgery, Hmong patients had a high rate (44%) of having a positive margin (likely cancer left behind in the body) compared to 9.7% of non-Hispanic White patients. Asian patients had a 28.2%-32% chance of the cancer spreading to the lymph nodes compared to 19.8% of non-Hispanic White patients. Spread to other organs such as lung and bone was most common in the Japanese (9.5%) and Filipino (8.8%) populations. Asian Indians had the highest 5- and 10-year overall survival (98.3% and 95.7%). Laotian patients had the lowest 5-year overall survival (90.7%), and Kampuchean patients the lowest 10-year overall survival (84.2%).

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study suggests that Chinese, Japanese, and Filipino patients are at increased risk of having thyroid cancer spread to the lymph nodes and other organs as well as more aggressive or fast-growing cancer. Chinese, Korea, Vietnamese, Asian Indian, and Pacific Islanders had a lower risk of death than non-Hispanic White patients, but other Asian subgroups did not. These results suggest that patients may benefit from more personalized thyroid cancer treatments. It is important to separate out the various ethnicities in the AAPI populations to better observe trends in the way patients present with the disease and respond to treatment.

— Pinar Smith, MD

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