Coexisting CLT in PTC is an independent predictor of tumor aggressiveness for patients aged under 55: a retrospective analysis of 635 patients

Abstract

Background The study was aimed at investigating the potential role of chronic lymphocytic thyroiditis (CLT) in papillary thyroid cancer (PTC) aggressiveness for patients aged below 55, as well as to figure out factors influencing potential recurrence risk in different age groups. Methods A total of 635 adult patients were retrospectively analyzed. 188 patients were diagnosed with coexistent CLT and the remaining 447 were classified as non-CLT. Then the characteristics of CLT-coexisted patients and non-CLT ones were compared respectively when patients were aged ≥ 55 years or below. The association among postoperative clinicopathological features were also analyzed using multivariate regression. In addition, the prognostic value of several variables relating to high-risk recurrence were estimated within different age groups. Results When divided in two age groups (55 years as the borderline), non-CLT group (aged below 55 years) had a remarkable frequency of small size lesion (Dmax ≤ 1 cm) compared with CLT-coexisted patients (54.6% to 43.0%, p = 0.02). In addition, non-CLT patients tended to have intrathyroidal extension as opposed to those with coexistent CLT (20.2% to 28.2%, p = 0.05). In multivariate analysis, CLT still significantly acted as an independent risk factor of greater lesion size (Dmin > 1 cm) (OR = 1.7, p = 0.02) and mildly promoted gross extrathyroidal extension (ETE) (OR = 1.4, p = 0.06). However, associations didn’t emerge in the characteristics mentioned above with CLT when patients were ≥ 55 years old. The prognostic value of CLT in high-risk recurrence was evident only in patients aged 35–44 years. (OR = 2.4, 95%CI:1.2–5.4, p = 0.02). Greater lesion size independently promoted gross ETE, no matter patients were aged above 55 years or not. Its prognostic value of high-risk recurrence was significant throughout all age groups. Conclusion These findings revealed that CLT coexistence might be the unfavorable factor of PTC aggressiveness in patients aged below 55 years. Its role as well as greater tumor size may potentially predict higher recurrence risk according to results figured out in the prediction model.

Hashimoto’s Thyroiditis and Papillary Thyroid Carcinoma: A Follow-Up Study in Patients with Absence of Aggressive Risk Factors at the Surgery of the Primary Tumor

“…The results obtained in this study related to the aggressiveness of PC in patients with HT were also observed by other authors [21,30,31]. Among these, several pathologic features of aggressiveness have also been observed in a study conducted of patients with HT associated with PC in areas of endemic goiter with iodine deficiency, in which the PC variant constituted 74.1% of thyroid cancer [54].…”

“…However, it is a matter of controversy whether the behavior of the carcinomas is more aggressive when the two diseases are associated with thyroid cancer. It has been observed that the appearance of metastatic lesions during follow-up is more frequent in patients with PC/GD [34][35][36][37] and PC/HT [21,22,30,31] than in PC patients without these autoimmune diseases. However, other studies have observed no difference in the outcome in the patients with or without GD and HT [15,38,39], while others have suggested that the two diseases may be factors of a more favorable disease course [3,8,[10][11][12][13]20,40,41].…”

“…In further studies, it has also been observed that HT may have only a minimal impact on the development of the tumor and may not modify its aggressiveness [9]. For others, PC and chronic thyroiditis coexistence might be the unfavorable factor of PC in patients <55 years and the predictor of higher recurrence risk [21].…”

Germline polymorphisms of the NOD2 pathway may predict the effectiveness of radioiodine in differentiated thyroid cancer treatment

“…Inflammation within the thyroid gland, as observed in CLT, may create an environment conducive to the initiation or progression of thyroid cancer [5,13,14]. However, the exact relationship between inflammation and the development of DTC is complex and requires further investigation to determine the mechanisms involved and the extent of their influence on cancer progression [15,16]. Moreover, data on the impact of the CLT on the clinical and pathological parameters of DTC are ambiguous [15][16][17][18][19][20][21].…”