Comparison of Survival and Risk Factors of Differentiated Thyroid Cancer in the Geriatric Population

Abstract

Purpose: The incidence rate of differentiated thyroid cancer (DTC), the most common type of thyroid cancer, has increased in the past two decades. The present study analyzed the clinical and pathological characteristics of DTC, and discussed the risk factors for survival in elderly age-risk DTC patients.Methods: Elderly patients who were diagnosed with DTC, and subsequently underwent surgery for DTC, were identified from the SEER database . Based on histology, these patients were divided into C-PTC, FV-PTC, and FTC. The clinical characteristics, pathological features, and treatments undertaken were compared among these patients. Cox proportional hazards analysis was performed to evaluate the risk factors to disease-specific survival (DSS). Results:In elderly DTC patients, FV-PTC shows intermediate tumor features compared to C-PTC and FTC, but presented a better outcome. Being male, African-American, tumors sized bigger than 4 cm, extrathyroidal extension, lymph node metastasis, and distant metastasis, were all strong risk factors for DSS in elderly DTC patients (all p < 0.05). No difference was found between lobectomy and total thyroidectomy with respect to DSS, and radiation therapy conferred no apparent advantage with respect to DSS (both p > 0.05).Discussion: Patients with FV-PTC needed more specific histology cataloging and risk assessment, suggesting conservative therapy. Risk stratification should be paid attention to, and treatment should be individualized for elderly patients.

The Age Threshold of the 8th Edition AJCC ClassificationIs Useful for Indicating Patients with Aggressive Papillary Thyroid Cancer in Clinical Practice.

“…In our study, we found that an age of 55 years is a clearly useful cut-off threshold for stratifying PTC patients, with patients younger and older than this age having better and poorer prognoses, respectively, consistent with a recent study (14). Those authors used Cox proportional hazards analysis to assess the association between speci c risk factors and the prognosis of WDTC and showed, consistent with our ndings, that an age of 55 years is an effective cut-off threshold for risk strati cation in PTC patients.…”

“…The current 8 th Edition AJCC TNM classi cation system uses an age of 55 years as a cut-off point for risk strati cation in tumor staging (13). By contrast, the previous traditional TNM staging system used an age of 45 years (13) as a cut-off for staging, and the change to 55 years prompted a debate regarding how clinically well-founded this age cutoff point is for PTC risk strati cation, with some authors questioning the utility of using either threshold for risk strati cation (14) and others proposing that the age threshold for staging PTC should be further increased (8). For example, a previous study showed that in PTC, overall survival decreases incrementally with age and that the optimal age threshold for PTC patients is 58.5 years (8).…”

“…The same researchers (8) also proposed that in terms of the age threshold for risk strati cation, PTC should not be evaluated using the same criteria as those used for FTC, and these conditions should instead be viewed as different forms of WDTC. Other authors have proposed that among older patients, there is no suitable age cutoff for decreasing surveillance (14). Hence, while many authors agree that age is one of the most important factors for risk strati cation, there is disagreement regarding what the age cut-off should be or whether such a cut-off should be applied at all (15).…”

The Age Threshold of the 8th Edition AJCC Classification Is Useful for Indicating Patients with Aggressive Papillary Thyroid Cancer in Clinical Practice.&nbsp;

“…The current 8 th Edition AJCC TNM classi cation system uses an age of 55 years as a cut off point for risk strati cation in tumor staging (13). By contrast, the previous traditional TNM staging system used an age of 45 years (13) as a cut off for staging, and the change to 55 years prompted a debate regarding how clinically wellfounded this age cut off point is for PTC risk strati cation, with some authors questioning the utility of using either threshold for risk strati cation (14) and others proposing that the age threshold for staging PTC should be further increased (8). For example, a previous study showed that in PTC, overall survival decreases incrementally with age and that the optimal age threshold for PTC patients is 58.5 years (8).…”

“…The same researchers (8) also proposed that in terms of the age threshold for risk strati cation, PTC should not be evaluated using the same criteria as those used for FTC, and these conditions should instead be viewed as different forms of WDTC. Other authors have proposed that among older patients, there is no suitable age cut off for decreasing surveillance (14). Hence, while many authors agree that age is one of the most important factors for risk strati cation, there is disagreement regarding what the age cut off should be or whether such a cut off should be applied at all (15).…”