LIFE EXPECTANCY AND TREATMENT PATTERNS IN ELDERLY PATIENTS WITH LOW RISK PAPILLARY THYROID CANCER: A POPULATION BASED ANALYSIS

Abstract Background Guidelines now endorse active surveillance for low risk PTC, but this approach is not commonly utilized. Those with limited life expectancy due to age and comorbidity may be best suited for active surveillance given their higher likelihood of other-cause mortality compared to disease-specific mortality. Methods SEER-Medicare was queried for patients \u003e65 years with T1, N0, M0 PTC who received surgery. We evaluated OS and DSS, and survival based on tumor size and extent of surgery (hemi- vs total-thyroidectomy). We performed a matched pair analysis comparing OS between the cancer cohort and patients matched for age, sex, and race. We created a competing risk model to identify the cumulative incidence of other-cause mortality to define groups of patients with life expectancy less than 10 and 15 years. Results A total of 3,280 patients were included in the analysis. The 20-year OS and DSS were 38.2% and 98.5% respectively. DSS was comparable between patients based on tumor size and treatment extent, and survival was better in the cancer cohort compared to matched controls (p 80 regardless of Charlson Comorbidity Score (CCS ≥0), and any patient age \u003e70 with CCS ≥1. Life expectancy was less than 10 years for any patient age \u003e80 with CCS ≥1, and any patient age \u003e70 with CCS ≥3. Conclusion Older patients with comorbidities have limited life expectancies but excellent DSS from low risk PTC. Incorporating life expectancy into management decisions and guidelines, as in other cancer types, would likely promote the selection of less aggressive management for populations that are most suited for this approach.