Analysis of Age and Disease Status as Predictors of Thyroid Cancer-Specific Mortality Using the Surveillance, Epidemiology, and End Results Database

Orosco, Ryan K.; Hussain, Timon; Brumund, Kevin T.; Oh, Deborah K.; Chang, David C.; Bouvet, Michael

doi:10.1089/thy.2014.0116

Cited by 111 publications

(83 citation statements)

References 26 publications

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“…However, there is evidence that age adds to the risk of mortality starting at age 35 (14,15). Furthermore, recent studies by Orosco et al (16) and by Londero et al (17) have suggested that although age is an important prognostic factor, there is no specific age cut off which predicts survival. Recent studies by Yang et al (18) and Banerjee et al (19) using SEER data have also reported evidence that death increases progressively with increasing age and that age as a continuous variable may be more appropriate.…”

Section: Discussionmentioning

confidence: 99%

Survival from Differentiated Thyroid Cancer: What Has Age Got to Do with It?

Ganly

Nixon

Wang

et al. 2015

Thyroid

145

110

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Background: In most staging systems, 45 years of age is used to differentiate low risk thyroid cancer from high risk thyroid cancer. However, recent studies have questioned both the precise 45 year age point and the concept of using a binary cut off as accurate predictors of disease specific mortality. Methods: A cohort of 3664 thyroid cancer patients that received surgery and adjuvant treatment at Memorial Sloan Kettering Cancer Center (MSKCC) from the years 1985 to 2010 were analyzed to determine the significance of age at diagnosis as a categorical variable at a variety of age cutoffs (5 year intervals between 30 and 70 years of age). The unadjusted and adjusted hazard ratio for the association between disease-specific survival and age was determined using a Cox proportional hazards model adjusted for other predictive variables sex, histology, and pathological T, N, and M status. Furthermore, predictive nomograms of disease-specific mortality were created and validated on an external dataset of 4551 patients to evaluate the impact of age at diagnosis as both a categorical and continuous variable. Results: In the MSKCC cohort, with a median follow-up time of 54 months (range 1-332), there were 59 deaths from thyroid cancer with a 10 year disease-specific survival of 96%. Adjusted hazard ratios for all age cutoffs from age 30 to age 70 years were significant. There was no specific cutoff age which risk stratifies patients with differentiated thyroid cancer (DTC). Categorizing age into five strata (<40, 40-49, 50-59, 60-69 and >70 years) showed a 37-fold increase in hazard ratio from age <40 years to age >70 years. A predictive nomogram using age as a continuous variable with other predictive variables had a high concordance index of 96%. Validation on the external cohort had a concordance index of 73%. Conclusions: Mortality from DTC increases progressively with advancing age. There is no specific cutoff age which risk stratifies patients with DTC. A predictive nomogram using age as a continuous variable may be a more appropriate tool for stratifying patients with DTC and for predicting outcome.

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Section: Discussionmentioning

confidence: 99%

Survival from Differentiated Thyroid Cancer: What Has Age Got to Do with It?

Ganly

Nixon

Wang

et al. 2015

Thyroid

145

110

View full text Add to dashboard Cite

show abstract

“…For mortality however, rates were increased in patients over 40 years old. In fact, most of the staging systems include age at the diagnosis as a significant prognostic factor (17). In several staging systems, such as TNM, AMES and MACIS, age has been adopted as a factor to be taken into account (18,19).…”

Section: Discussionmentioning

confidence: 99%

“…(20), it was also shown that the prognosis in patients with DTC has a bimodal curve where the risk of nodal recurrence is higher in patients younger than 20 and older than Although it has been recognized that mortality caused by thyroid cancer would be increased as from 35 years and with the advancing age (21), it has been recently observed that the AJCC staging could overestimate the protective effect of the lower age in patients with DTC, especially in the context of the metastatic disease, resulting in substaging of young patients (22). In fact, young patients with both T3 tumours or with N1b nodal disease have a worse prognosis than older adults within the same TNM stage (17). In addition (23), it has been shown that, in the case of papillary microcarcinoma, the ratio of patients with tumour progression, i.e., progression to clinical disease was lower in adults over 60 than in patients younger than 40 years of age.…”

Section: Discussionmentioning

confidence: 99%

Dynamic prediction of the risk of recurrence in patients over 60 years of age with differentiated thyroid carcinoma

Morosan

Parisi

Urrutia

et al. 2016

Arch. Endocrinol. Metab.

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Objective: The reclassification of the risk according to the response to the initial treatment makes the treatment of differentiated thyroid cancer (DTC) vary in each individual. As the influence of age on this diagnostic strategy is unknown, we have decided to assess it in adults who are over 60 years of age. Subjects and methods: Ninety patients with DTC above 60 years old were enrolled, with total thyroidectomy plus radioiodine ablation, negative anti-thyroglobulin antibodies, follow-up ≥ 2 years and with clinical and pathological information to classify the risk of recurrence according to ATA (American Thyroid Association) and reclassify based on the response to initial therapy according to MSKCC (Memorial Sloan Kettering Cancer Center). The structural persistence at the end of the follow-up was the gold standard of our analysis. Results: The structural persistence in ATA low, intermediate and high risk categories was 0, 38, and 100%, respectively. In the intermediate group, none of those with an excellent response to the initial treatment showed structural persistence, whereas 39% of those with an incomplete/indeterminate response showed structural persistence (p < 0.01). Conclusions: The re-stratification according to the response to the initial treatment in patients over 60 years of age with an ATA intermediate risk of recurrence allowed for the distinction of disease-free patients at the end of the follow-up from those with structural persistence and a worse clinical progression. Arch Endocrinol Metab. 2016;60(4):348-54

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“…The cancer-specific mortality rate is <5% of patients with PTC, and most patients have an excellent prognosis. [5] The removal of the residual thyroid tissue in the case of detected malignancy after lobectomy has practical benefits regarding patients' treatment. [6] Completion thyroidectomy (CT) is the conversion of the process to total thyroidectomy (TT) by the removal of the residual thyroid tissue after subtotal thyroidectomy.…”

mentioning

confidence: 99%

“…The reason for preferring lobectomy is to avoid unnecessary thyroidectomies in patients with fine needle aspiration (FNA) biopsy that is suspiciously malignant or those that are indeterminate following FNA. [5,6] Thyroid lobectomy is the recommended initial surgical approach in patients with solitary, cytologically indeterminate nodule, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), or follicular neoplasm/suspicious for follicular neoplasm (FN/ SFN) according to the 2015 American Thyroid Association (ATA) guidelines. However, this approach may be modified according to the clinical or sonographic characteristics of the patient and patient preference or molecular tests.…”

mentioning

confidence: 99%

Completion thyroidectomy in patients diagnosed with papillary thyroid cancer: is there a predictive factor for contralateral lobe tumor?

et al. 2018

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T hyroid nodules are one of the most common endocrine pathologies in adult populations and can be diagnosed by physical examination (4%-8%), ultrasonographic examination (10%-41%), and autopsy (50%).[1] Though the majority of these nodules are benign, thyroid carcinoma is detected in approximately 5% of the cases. [2,3] Papillary thyroid cancer (PTC) is the most frequent histological subtype of thyroid cancer, and the incidence of PTC increases over the years.[4] It usually has an indolent course, rarely showing aggressive behavior. Although PTC prognosis is good, Objectives: Completion thyroidectomy (CT) is defined as the removal of the residual thyroid tissue in the case of detected malignancy after lobectomy for an indeterminate or non-diagnostic biopsy. Factors such as tumor diameter, aggressive histology, extrathyroidal spread, and positive surgical margin in papillary thyroid cancer (PTC) constitute CT indications. However, the type of surgery is controversial especially in patients with a tumor diameter of 1-4 cm. Determination of predictive factors for contralateral lobe tumors (CLTs) in PTC may be helpful for rough or excessive treatment of patients with this common thyroid pathology. The aim of the present study was to determine the predictive factors and rate of detection of CLTs after CT in patients with papillary thyroid carcinoma after lobectomy. Methods: Medical records of patients who underwent lobectomy with the final histological diagnosis of papillary thyroid carcinoma for the study period 2011 to 2016 were reviewed. Demographic data of the patients, diameter, multicentricity and subtype of tumor, extrathyroidal spread, and vascular invasion rate were obtained. Patients were divided into 2 groups as final histological examination after CT revealed benign (Group 1) and malignant (Group 2). Results: Data of 49 patients were retrospectively analyzed during the study period. The female-to-male ratio was 33/16. The mean age of the patients was 47.59 (23-77) years. Groups 1 and 2 consisted of 30 and 19 patients, respectively. No significant difference was found between the two groups regarding demographic data and tumor characteristics. Conclusion: Despite the fact that we have not been detecting any predictive factor in predicting the presence of tumor on the contralateral lobe in our study, the detection of a tumor on the contralateral lobe is frequent.

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Analysis of Age and Disease Status as Predictors of Thyroid Cancer-Specific Mortality Using the Surveillance, Epidemiology, and End Results Database

Cited by 111 publications

References 26 publications

Survival from Differentiated Thyroid Cancer: What Has Age Got to Do with It?

Survival from Differentiated Thyroid Cancer: What Has Age Got to Do with It?

Dynamic prediction of the risk of recurrence in patients over 60 years of age with differentiated thyroid carcinoma

Completion thyroidectomy in patients diagnosed with papillary thyroid cancer: is there a predictive factor for contralateral lobe tumor?

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