Understanding surgical decision-making in older adults with differentiated thyroid cancer: A discrete choice experiment.
Understanding surgical decision-making in older adults with differentiated thyroid cancer: A discrete choice experiment.
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DOI：
10.1016/j.surg.2020.03.022
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发表时间：
2021-01
期刊：
影响因子：
3.8
通讯作者：
Mathur A
中科院分区：
文献类型：
--
作者：
Sutton W;Genberg B;Prescott JD;Segev DL;Zeiger MA;Bandeen-Roche K;Mathur A
先前的研究表明，老年人往往较少接受甲状腺癌手术。我们的目标是利用离散选择实验来确定影响老年甲状腺癌患者手术决策的因素。美国内分泌外科医生协会的活跃成员和候选成员被邀请参加一项基于网络的调查。多项Logistic回归(MNL)用于评估患者和外科医生与治疗选择相关的因素。调查完全应答率为25.7%。大多数受访者是学术中心的大容量外科医生(88.5%)(76.9%)。MNL表明，患者年龄是管理的最强预测因子。年龄和合并症的增加与选择主动监测(P=0.000)、不进行淋巴结清扫术(RRR：2.5，95%CI：1.4~4.2，P=0.002和RRR：1.6，95%CI：1.2~2.1，P=0.004)和推荐半甲状腺切除与全甲状腺切除(RRR：4.4，95%CI：2.5~7.9，P=0.000和RRR：3.4，95%CI：2.3~5.1，P=0.000)有关。有10年≥经验的外科医生(RRR：3.3，95%CI：1.1~10.3，P=0.039)倾向于对直径4 cm的肿瘤行全甲状腺切除术，而未受过团契训练的外科医生(RRR：7.3，95%CI：1.3~42.2，P=0.027)选择甲状腺切除不加淋巴结清扫来治疗侧颈淋巴结转移。这项研究强调了老年人甲状腺癌手术治疗的多样性，并展示了患者年龄、合并症、外科医生经验和团契培训对这一人群管理的影响。这项研究强调了老年甲状腺癌患者大容量内分泌外科医生治疗模式的差异，并利用离散选择实验方法论证了患者年龄、合并症和外科医生特征对手术决策的影响。了解影响治疗决策的因素对于制定专门针对老年人甲状腺癌治疗的风险指数和指南，以便标准化一致的治疗是很重要的。
Prior studies demonstrate that older adults tend to undergo less surgery for thyroid cancer. Our objective was to utilize a discrete choice experiment to identify factors influencing surgical decision-making for older adults with thyroid cancer. Active and candidate members of the American Association of Endocrine Surgeons were invited to participate in a web-based survey. Multinomial logistic regression (MNL) was utilized to assess patient and surgeon factors associated with treatment choices. Complete survey response rate was 25.7%. Most respondents were high volume surgeons (88.5%) at academic centers (76.9%). MNL demonstrated that patient age was the strongest predictor of management. Increasing age and comorbidities were associated with the choice for active surveillance (P=0.000), not performing a lymphadenectomy in patients with nodal metastases (RRR:2.5,95%CI:1.4–4.2,P=0.002 and RRR:1.6,95%CI:1.2–2.1,P=0.004, respectively) and recommending hemithyroidectomy versus total thyroidectomy for a cancer>4cm (RRR:4.4, 95%CI:2.5–7.9,P=0.000 and RRR:3.4,95%CI:2.3–5.1,P=0.000, respectively). Surgeons with≥10 years of experience (RRR:3.3,95%CI:1.1–10.3,P=0.039) favored total thyroidectomy for a cancer<4cm, and non-fellowship trained surgeons (RRR:7.3,95%CI:1.3–42.2,P=0.027) opted for thyroidectomy without lymphadenectomy for lateral neck nodal metastases. This study highlights the variation in surgical management of older adults with thyroid cancer and demonstrates the influence of patient age, comorbidities, surgeon experience, and fellowship training on management of this population. This study highlights the variation in treatment patterns among high volume endocrine surgeons for older adults with thyroid cancer, and demonstrates the impact of patient age, comorbidities, and surgeon characteristics on surgical decision-making by utilizing the discrete choice experiment methodology. The understanding of factors that affect treatment decisions is important for the development of risk indices and guidelines specific to the management of older adults with thyroid cancer in order to standardize consistent treatment.
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影响因子：
45.3
作者：
Lerch, H;Schober, O;Saur, HB
通讯作者：
Saur, HB
影响因子：
6.6
作者：
Ito, Yasuhiro;Miyauchi, Akira;Miya, Akihiro
通讯作者：
Miya, Akihiro
影响因子：
6.6
作者：
Ito, Yasuhiro;Miyauchi, Akira;Miya, Akihiro
通讯作者：
Miya, Akihiro
DOI：
10.1200/jco.2010.30.8650
发表时间：
2011-02-20
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
Nathan H;Bridges JF;Schulick RD;Cameron AM;Hirose K;Edil BH;Wolfgang CL;Segev DL;Choti MA;Pawlik TM
通讯作者：
Pawlik TM
影响因子：
--
作者：
Seybt, Melanie W.;Khichi, Sunny;Terris, David J.
通讯作者：
Terris, David J.