Lack of association between obesity and aggressiveness of differentiated thyroid cancer

Grani, Giorgio; Lamartina, Livia; Montesano, Teresa; Ronga, Giuseppe; Maggisano, Valentina; Falcone, Rosa; Ramundo, Valeria; Giacomelli, Luciano; Durante, Cosimo; Russo, Diego; Maranghi, Marianna

doi:10.1007/s40618-018-0889-x

Cited by 47 publications

(40 citation statements)

References 33 publications

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“…Another factor that should be taken into account when considering the role of obesity in thyroid cancer is the potential for a delay in diagnosis due to difficulties in detecting thyroid nodules during neck examinations of obese patients. Although the present study and others did not find increased BMI to be associated with larger tumor [ 26 , 51 , 52 ], other studies have observed this trend [ 47 , 48 , 55 ]. Additionally, Tresallet et al reported that obese patients with PTC >10 mm had an increased risk of persistent / recurrent disease (OR = 3.8, 95% CI: 1.6–8.8; p = 0.03)[ 55 ].…”

Section: Discussioncontrasting

confidence: 89%

“…In the current study of patients with DTC, there was no relationship between BMI and aggressive clinicopathological features, the degree of clinical progression, the response to primary treatment, or the outcome of the disease. In addition, BMI was not a significant predictor of high or intermediate risk of recurrence according to the ATA Risk Stratification system, as reported by Grani et al [ 52 ]. Our results are in line with those of Kwon et al [ 51 ], in which the authors did not find any association between BMI and clinicopathological features of thyroid cancer or disease outcome.…”

Section: Discussionsupporting

confidence: 57%

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The impact of BMI on clinical progress, response to treatment, and disease course in patients with differentiated thyroid cancer

Gąsior-Perczak¹,

Pałyga²,

Szymonek³

et al. 2018

PLoS ONE

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IntroductionObesity is a serious health problem worldwide, particularly in developed countries. It is a risk factor for many diseases, including thyroid cancer. The relationship between obesity and prognostic factors of thyroid cancer is unclear.AimsWe sought to ascertain the relationship between body mass index (BMI) and clinicopathological features increasing the risk of poor clinical course, treatment response, and clinical outcome in patients with differentiated thyroid cancer (DTC).Subjects & methodsThe study included 1181 patients with DTC (88% women and 12% men) treated at a single center from 2000 to 2016. BMI before surgery and aggressive clinicopathological features, according to the American Thyroid Initial Risk stratification system, were analyzed. The relationship between BMI and initial risk, treatment response, and final status of the disease was evaluated, incorporating the revised 2015 American Thyroid Association guidelines and the 8th edition of the American Joint Committee on Cancer/Tumor-Node-Metastasis (AJCC/TNM) staging system. Patients were stratified according to the World Health Organization classification of BMI. Statistical analysis was performed using univariate and multivariate logistic regression analysis.ResultsMedian follow-up was 7.7 years (1–16 years). There were no significant associations between BMI and extrathyroidal extension (microscopic and gross), cervical lymph node metastasis, or distant metastasis in univariate and multivariate analyses. BMI did not affect initial risk, treatment response or disease outcome. Obesity was more prevalent in men (p = 0.035) and in patients ≥55 years old (p = 0.001). There was no statistically significant relationship between BMI and more advanced TNM stage in patients ≤55 years old (stage I vs. stage II) (p = 0.266) or in patients >55 years old (stage I–II vs. III–IV) (p = 0.877).ConclusionsObesity is not associated with more aggressive clinicopathological features of thyroid cancer. Obesity is not a risk factor for progression to more advanced stages of disease, nor is it a prognostic factor for poorer treatment response and clinical outcome.

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Section: Discussioncontrasting

confidence: 89%

Section: Discussionsupporting

confidence: 57%

The impact of BMI on clinical progress, response to treatment, and disease course in patients with differentiated thyroid cancer

Gąsior-Perczak¹,

Pałyga²,

Szymonek³

et al. 2018

PLoS ONE

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“…Obesity was positively related to papillary, follicular and anaplastic thyroid cancers, but negatively with medullary thyroid cancer (75). The impact of obesity on thyroid cancer aggressiveness has still to be defined (76). Importantly, data showing that early detection of thyroid cancer by systematic ultrasound assessment improve the prognosis of thyroid cancer in patients with obesity are lacking.…”

Section: Reasoningmentioning

confidence: 99%

European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

Pasquali

Casanueva

Haluzı́k

et al. 2020

European Journal of Endocrinology

126

156

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Obesity is an emerging condition, with a prevalence of ~20%. Although the simple measurement of BMI is likely a simplistic approach to obesity, BMI is easily calculated, and there are currently no data showing that more sophisticated methods are more useful to guide the endocrine work-up in obesity. An increased BMI leads to a number of hormonal changes. Additionally, concomitant hormonal diseases can be present in obesity and have to be properly diagnosed – which in turn might be more difficult due to alterations caused by body fatness itself. The present European Society of Endocrinology Clinical Guideline on the Endocrine Work-up in Obesity acknowledges the increased prevalence of many endocrine conditions in obesity. It is recommended to test all patients with obesity for thyroid function, given the high prevalence of hypothyroidism in obesity. For hypercortisolism, male hypogonadism and female gonadal dysfunction, hormonal testing is only recommended if case of clinical suspicion of an underlying endocrine disorder. The guideline underlines that weight loss in obesity should be emphasized as key to restoration of hormonal imbalances and that treatment and that the effect of treating endocrine disorders on weight loss is only modest.

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“…Similarly, a strong U-shaped association exists between iodine intake and the frequency of diffuse goiter, with low and high iodine intakes associated with increased rates of thyroid disease; nevertheless, the risk of nodular goiter is perhaps increased only at low intakes 424344Table 1. details other risk factors 1835384546474849505152535455565758596061…”

Section: Risk Factors For Thyroid Nodules and Thyroid Malignancymentioning

confidence: 99%

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Ospina

Iñiguez-Ariza

Castro

2020

BMJ

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Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient’s values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.

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Lack of association between obesity and aggressiveness of differentiated thyroid cancer

Abstract: Obesity was not associated with aggressive features in this prospective, European cohort of patients with DTC.

Cited by 47 publications

References 33 publications

The impact of BMI on clinical progress, response to treatment, and disease course in patients with differentiated thyroid cancer

The impact of BMI on clinical progress, response to treatment, and disease course in patients with differentiated thyroid cancer

European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

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