Impact of age on survival in radioiodine refractory differentiated thyroid cancer patients

Abstract

OBJECTIVE The objectives of our study were to analyze the influence of age on the survival of patients with RAIR-DTC and to determine their prognostic factors according to age. METHODS This single centre, retrospective study enrolled 155 patients diagnosed with RAIR-DTC. The primary end point was overall survival (OS) according to different cut-off (45,55,65,75 years). Secondary endpoints were progression free survival (PFS) and prognostic factors in patients under and over 65 years. RESULTS Median OS after RAIR diagnosis was 8.2 years (95% IC: 5.3-9.6). There was no difference according to age with a 65 (p=0.47) and 55 years old cut-off (p=0.28). Median OS was significantly improved before 45 years old (p=0,0043). After 75 years old, median OS significantly decrease (p= 0,0008). Median PFS was 2.1 years (95% CI: 0.8-3) in patients < 65 years, and 1 year in patients ≥ 65 years (95% CI: 0.8-1.55) with no statistical difference (p=0.22). There was no impact of age on PFS with any cut-off. In both groups, progressive disease despite 131I treatment reduced OS. In patients < 65, an interval of less than 3 years between the initial diagnosis and the diagnosis of RAIR metastatic disease was predictive of poor survival. In patients > 65, the presence of a mediastinum metastasis was a significant factor for mortality (HR: 4.55, 95% CI: 2.27-9.09). CONCLUSION In RAIR-DTC patients, a cut-off age of 65 years old was not a significant predictive factor of survival. 45 and 75 years old cut off were predictive for OS, but not PFS.

Salvage surgery for cervical radioiodine refractory 18F-FDG-PET positive recurrence of papillary thyroid cancer

“…Another observation in our study was the fact that patients who experienced biochemical and radiological cure were significantly younger, consistently with the recent increase of the age cut-off for risk stratification in PTC from 45 to 55 years in the TNM-8 ( 23 ): patients experiencing progression were older than 55 in this study. Recent data also confirm increased overall survival in patients with radioiodine refractory disease younger than 45 ( 24 ). A further result was that patients, who could not be cured by surgery, more frequently displayed loco-regional recurrence instead of lymph nodal recurrence.…”

Strategies for Radioiodine Treatment: What’s New

“…In RAI refractory patients, an age of >60 years-old (HR = 8.498, CI 95:1.555–46.427, p = 0.0135) and the male gender (HR = 5.435, CI 95:1.261–23.256, p = 0.0231) negatively affected patients’ survival [ 176 ]. However, Saie et al [ 177 ] observed a reduction in the overall survival (4.65 years, 95% CI: 2.04–5.68, p = 0.0008) only in patients older than 75 years, while they failed to prove an association between age and progression-free survival in their cohort. Other reports did not confirm the negative prognostic role of age in PDTCs, even considering different thresholds [ 178 ].…”

A nomogram for predicting overall survival in patients with follicular thyroid cancer after thyroidectomy: a SEER database analysis

“…In this study, age was a significant independent factor for survival in patients with FTC. Several studies have shown that the prognosis of elderly patients with TC is relatively poor ( 20 - 22 ). In addition, the relationship between older age and poor survival prognosis has been reported in many types of cancer ( 23 - 25 ).…”