Male sex is associated with aggressive behaviour and poor prognosis in Chinese papillary thyroid carcinoma

Abstract

The differences in prognosis of papillary thyroid carcinoma (PTC) by sex have been investigated in several previous studies, but the results have not been consistent. In addition, the impact of sex on the clinical and pathological characteristics, especially on central lymph node metastasis (CLNM), still remains unknown. To the best of our knowledge, the impact of sex on PTC has not been investigated in the Chinese PTC population. Therefore, our study retrospectively analysed the data of 1339 patients who were diagnosed with PTC and had received radical surgery at Ningbo Medical Center, Lihuili Hospital. In addition to cancer-specific death, structural recurrence and risk stratification, prognosis was also estimated by using three conventional prognostic systems: AMES (age, distant metastasis, extent, size), MACIS (distant metastasis, age, completeness of resection, local invasion, size) and the 8 th version TNM (tumor, lymph node, metastasis) staging system. The clinical and pathological characteristics and above prognostic indexes were compared between male and female PTC patients. The results showed that there were higher rates of non-microcarcinoma PTC (nM-PTC), CLNM, lateral lymph node metastasis (LLNM), advanced disease and bilateral disease, but there was a lower rate of concurrent Hashimoto's thyroiditis (HT) in male PTC patients than in female PTC patients. Additionally, the rate of intermediate-risk, high-risk or advanced disease was higher in male PTC patients. The above findings indicate that PTC in men is a more aggressive disease and may have a worse prognosis; thus, it should be treated with more caution.In some cancers that occur in both sexes, such as thyroid, lung and liver cancer, there is an obvious difference in incidence between sexes 1-3 . Thyroid cancer is a malignancy of the endocrine system that has been rapid-growing in recent years, and it was reported that the incidence of thyroid cancer in women and men was 13.5 and 3.70 per 100,000 persons, respectively, in China in 2012 4 .Previous studies demonstrated that PTC in men had a worse prognosis than in women 2,5 , which was easily to be explained by epidemiologic data. The ratio of the mortality rate to the incidence rate, also called as the death/ incidence ratio, is a useful index to indicate the prognosis of a disease. Since the estimated incidence rate of PTC in women was 3-fold higher than that in men 6,7 , and the estimated death rate in women was only 1.3-fold higher than that in men 7 , the death/incidence ratio in men should be higher than that in women. However, Yorke E et al. found a similar prognosis in men and in women when the influencing factors including patient age, tumour size, lymph node status, and extrathyroidal extension were balanced 8 .However, the above studies were from outside mainland China. Additionally, the influence of sex on clinical and pathological characteristics, especially on central lymph node (CLN) status, is currently unclear. The 2009 and revised 2015 versions of the American Thyroid Association ...

A Nomogram Predicting Central Lymph Node Metastasis for Patients with Papillary Thyroid Cancer

“…Besides, a relatively smaller sample size compared with other large cohort studies also contributed to this difference. Hence, gender, age, tumor size, and HT were nally screened out for multivariable analysis, similar to the recently reported studies 28,29 . Interestingly, it's believed that tumor size was one of the pivotal risk factors in CLNM and the risk of CLNM increased as the diameter of the primary nodule increases.…”

How gender influence the health state? A cross sectional study in an endocrine setting

“…In our study, thyroid malignancies were more frequent in males than females.The risk of malignancy of the thyroid nodules is known to be greater in males (31,32), and that male gender is an independent prognostic factors in papillary thyroid carcinoma, which influences staging and risk of recurrence (33,34). These factors together could explain the propensity to refer to a national cancer center in male patients.…”

COVID-19: Is there a weaker sex?

“…Sex is one of the most relevant factors often associated with health, disease severity, mortality, and life expectancy [ 1 ]. From neonatal diseases to non-communicable disorders, men often have higher risks and poorer prognosis; however, the causes of these disparities are still subject to debate [ [2] , [3] , [4] , [5] , [6] , [7] ]. In this context, the new coronavirus disease of 2019 (COVID-19) has again called attention to these differences, mainly due to the observations of a higher level of complications and fatality rates among men [ 8 ].…”

“…The physiological differences between the sexes may initially be directly involved in this differential risk of COVID-19 adverse outcomes [ 20 ]. For example, recent evidence has suggested that SARS-CoV-2 expression may induce angiotensin-converting enzyme-2 (ACE-2) downregulation due to the binding of the viral spike protein to its receptor, then promoting a decrease in the angiotensin- [ [1] , [2] , [3] , [4] , [5] , [6] , [7] ] production [ 21 ]. In this context, there is evidence suggesting an important role of sex hormones in the regulation of ACE-2 in a tissue-specific manner [ 20 ].…”

“…In this context, there is evidence suggesting an important role of sex hormones in the regulation of ACE-2 in a tissue-specific manner [ 20 ]. For example, female mice were observed to have a higher expression of ACE-2 in adipose tissue compared with male mice, leading to higher levels of Ang- [ [1] , [2] , [3] , [4] , [5] , [6] , [7] ], which in turn were associated with lower levels of hypertension, another risk factor for COVID-19 negative outcomes [ 22 , 23 ]. Similarly, higher testosterone levels in males may be related to a higher risk of coagulation disorders, resulting in complications such as venous thromboembolism and systemic embolisms, which are frequently observed in severe COVID-19 patients [ 24 , 25 ].…”