Male gender as a poor prognostic factor in medullary thyroid carcinoma: behavior or biological difference?

Costa, Cláudia Henrique da; Souteiro, Pedro; Paredes, Sílvia; Bettencourt‐Silva, Rita; Pedro, Jorge; Ferreira, Maria João; Salazar, Daniela; Teixeira, Manuel R.; Oliveira, J. M.; Santos, Ana Paula dos; Torres, Isabel

doi:10.23736/s2724-6507.22.03692-2

Cited by 3 publications

(4 citation statements)

References 26 publications

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“…However, DTC among our males exhibited relatively more aggressive features (lymphovascular invasion, number of tumors, stage 4 disease, metastases) than among females. Such higher aggressiveness among males is congruent with other studies [ 30 ] and propositions of sex difference in TC pathogenesis [ 31 ].…”

Section: Discussionsupporting

confidence: 92%

Behaviour and epidemiology of differentiated thyroid cancer among filipinos in and outside the Philippines: Comparison between Qatar, Canada and Philippines

Ghali

Ansari

Abdelaal

et al. 2022

Annals of Medicine &Amp; Surgery

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Section: Discussionsupporting

confidence: 92%

Behaviour and epidemiology of differentiated thyroid cancer among filipinos in and outside the Philippines: Comparison between Qatar, Canada and Philippines

Ghali

Ansari

Abdelaal

et al. 2022

Annals of Medicine &Amp; Surgery

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“…iodine therapy has a worse prognosis, while some studies have also reached similar conclusions, this effect is not found in the competing-risks model. We infer that these statistical results are due to the bias caused by competitive risk events [33,34].…”

Section: Plos Onementioning

confidence: 84%

“…Although the Cox proportional-hazards model results show that male relative to female, divorced / single relative to married, external radiation radiotherapy relative to radioactive iodine therapy has a worse prognosis, while some studies have also reached similar conclusions, this effect is not found in the competing-risks model. We infer that these statistical results are due to the bias caused by competitive risk events [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Competing-risks model for predicting the prognostic value of lymph nodes in medullary thyroid carcinoma

Shang,

Liu,

Ren

et al. 2023

PLoS ONE

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Background Medullary thyroid carcinoma (MTC) is an infrequent form malignant tumor with a poor prognosis. Because of the influence of competitive risk, there may suffer from bias in the analysis of prognostic factors of MTC. Methods By extracting the data of patients diagnosed with MTC registered in the Surveillance, Epidemiology, and End Results (SEER) database from 1998 to 2016, we established the Cox proportional-hazards and competing-risks model to retrospectively analyze the impact of related factors on lymph nodes statistically. Results A total of 2,435 patients were included in the analysis, of which 198 died of MTC. The results of the multifactor competing-risk model showed that the number of total lymph nodes (19–89), positive lymph nodes (1–10,11–75) and positive lymph node ratio (25%-53%,>54%), age (46–60,>61), chemotherapy, mode of radiotherapy (others), tumor size(2-4cm,>4cm), number of lesions greater than 1 were poor prognostic factors for MTC. For the number of total lymph nodes, unlike the multivariate Cox proportional-hazards model results, we found that it became an independent risk factor after excluding competitive risk factors. Competitive risk factors have little effect on the number of positive lymph nodes. For the proportion of positive lymph nodes, we found that after excluding competitive risk factors, the Cox proportional-hazards model overestimates its impact on prognosis. The competitive risk model is often more accurate in analyzing the effects of prognostic factors. Conclusions After excluding the competitive risk, the number of lymph nodes, the number of positive and the positive proportion are the poor prognostic factors of medullary thyroid cancer, which can help clinicians more accurately evaluate the prognosis of patients with medullary thyroid cancer and provide a reference for treatment decision-making.

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“…Male gender independently predicts worse overall survival in MTC, even if both disease burden at initial surgery and biochemical response to surgery appear to be stronger prognostic factors ( 40 ). Gender differences in term of MTC presentation and outcome could be attributed to a later diagnosis in men, for behavioral reasons and possibly for the lower tendency to perform thyroid tests compared to women, although an underlying biological explanation has been proposed recently but not yet confirmed in larger studies ( 41 ). Notably, men and women were almost numerically equal among E-MTC patients in the present study.…”

Section: Discussionmentioning

confidence: 99%

Is Encapsulated Medullary Thyroid Carcinoma Associated With a Better Prognosis? A Case Series and a Review of the Literature

et al. 2022

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ContextMedullary thyroid carcinoma (MTC) is a malignant neuroendocrine neoplasm that may spread to lymph nodes before the primary tumor is diagnosed; moreover, distant metastases are already present in about 10% of patients at diagnosis. Serum calcitonin (Ctn) usually reflects the spread of disease, thus orienting the extent of surgery and predicting the possibility of biochemical remission. Tumor size and vascular invasion are important prognostic factors, but little is known on the relationship between other histopathological features, such as the presence of a tumor capsule, and long term outcome of MTC.PurposeTo evaluate the prevalence of encapsulated tumors among MTCs and the association of tumor capsule with a favorable outcome after surgery.MethodsA retrospective observational single-center study was conducted together with a narrative review of the available literature.ResultsAmong 44 patients (27 female, 17 male; median age: 56 years) with MTC (6 hereditary, 37 sporadic) followed up at our center in the last four years (median follow-up: 29.2 months), seven (15.9%) showed an encapsulated tumor at histology and a clinical remission after surgery. None of them had nodal metastases and median preoperative Ctn (398 pg/mL, IQR 126.5–7336) did not differ significantly from that of the 14 patients (31.8%) with persistent disease after surgery (787 pg/mL, IQR 340.5–2905.5; p=0.633), although their tumor size was significantly higher (median 33 mm versus 16 mm respectively, p=0.036). Among patients with preoperative Ctn levels above 500 pg/mL (n=11), only two (18.2%) showed undetectable Ctn levels during follow-up, both having an encapsulated MTC (OR 0.000, p=0.02). Notably, they were two similar cases of large MTC (> 3 cm) with extensive hyalinization and calcification, associated with very high Ctn levels (> 13’500 and 1’100 pg/mL, respectively) but no nodal nor distant metastases, in complete remission after surgery although one of them carried the aggressive M918T somatic RET mutation.ConclusionMTC rarely shows a tumor capsule, which seems to correlate with a better prognosis and absence of nodal metastases, regardless of RET or RAS mutational status. Among encapsulated MTCs (E-MTC), Ctn levels and tumor size are not predictive of persistence of disease after surgery.

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Male gender as a poor prognostic factor in medullary thyroid carcinoma: behavior or biological difference?

Cited by 3 publications

References 26 publications

Behaviour and epidemiology of differentiated thyroid cancer among filipinos in and outside the Philippines: Comparison between Qatar, Canada and Philippines

Behaviour and epidemiology of differentiated thyroid cancer among filipinos in and outside the Philippines: Comparison between Qatar, Canada and Philippines

Competing-risks model for predicting the prognostic value of lymph nodes in medullary thyroid carcinoma

Is Encapsulated Medullary Thyroid Carcinoma Associated With a Better Prognosis? A Case Series and a Review of the Literature

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