More Aggressive Cancer Behaviour in Thyroid Cancer Patients in the Post-COVID-19 Pandemic Era: A Retrospective Study

Abstract

Many thyroid cancer patients have suffered from treatment delays caused by the coronavirus disease 2019 pandemic. Although there have been many reviews, recommendations, or clinical experiences, clinical evidence that evaluates patient disease status is lacking. The aim of our research was to evaluate thyroid cancer behaviour in the post-COVID-19 era. Patients and Methods: A retrospective study was conducted and thyroid cancer patient data from February 1, 2017 to September 15, 2020 were pooled for analysis. The demographic, ultrasound and pathological data of the pre-and post-COVID-19 groups were compared. Lymph node metastases, tumour size, extrathyroidal extension, and multifocality were compared year-by-year to evaluate annual changes in patient characteristics. Regression analyses were adopted to reveal cancer behaviour along with the admission date interval and to reveal risk factors for lymph node metastasis. Patient ultrasound data were compared before and after the lockdown to assess tumour progression. The outcomes of delays in treatment ≤180 days were then studied. Results: The post-lockdown patients were more likely to have multiple lesions (31.2% vs 36.5%, p = 0.040), extrathyroidal extension (65.5% vs 72.2%, p = 0.011) and lymph node metastases (37.7% vs 45.0%, p = 0.007), while tumour size remained stable (1.01cm vs.1.02cm, p = 0.758). The lymph node metastasis rate increased by year (p < 0.001). The tumour size correlated negatively with the post-lockdown admission date (p = 0.002). No significant difference in tumour size, multifocality or lymph node metastasis on ultrasound was revealed between the pre-and post-lockdown group. No significant difference in tumour size, multifocality, extrathyroidal extension or lymph node metastasis was revealed among patients with a delayed treatment time ≤180 days. Conclusion:Patients with a COVID-19-induced treatment delay had more aggressive cancer behaviour. Rebound medical visits and annually increasing aggressiveness may be potential reasons for this observation, as individual patient tumour did not progress during the delay.

The COVID-19 outbreak and de-escalation of thyroid cancer diagnosis and treatment

“…It has previously been reported that this changing paradigm did not affect the rate of postoperative complications [14]. Our study documented a slight increase in baseline risk stratification for patients who underwent thyroid surgery after the COVID-19 lockdown, consistent with reports from China, another country hit early by the pandemic [17], though this effect was less marked in our cohort. However, short-term outcomes, evaluated as the early response to initial treatment, were not negatively impacted by the delay.…”

Impact of COVID-19 Pandemic on Thyroid Surgery in a University Hospital in South Korea

“…According to reports from Italy and Jordan, there was no significant difference in the oncological severity of thyroid cancer patients before and after the outbreak of COVID-19 [ 16 , 35 ]. However, a study in China reported that the poor prognostic factors of thyroid cancer, including extrathyroidal extension, multiple tumors, and lymph node metastasis, increased after the COVID-19 outbreak [ 18 ]. In a survey study conducted with clinicians majoring in thyroid disease, 87.9% were worried about delayed treatment for their patients during the pandemic [ 36 ].…”

“…However, due to delayed diagnosis and treatment during the pandemic, thyroid cancer tended to progress to worse pathologic status, such as extrathyroidal extension and lymph node metastasis, even if most thyroid cancers typically exhibited indolent behavior. Currently, few studies worldwide have analyzed the changes in the oncologic features of thyroid cancer before and after the outbreak of COVID-19 [ 16 , 17 , 18 ]. Our aim was to analyze the clinical and pathologic characteristics of thyroid nodules and cancer patients before and after the outbreak of COVID-19 in a single university hospital in Incheon, Korea.…”

Thyroid Cancer and COVID-19: Prospects for Therapeutic Approaches and Drug Development

“…Most DTCs and MTCs are slow-growing tumors; surgical treatment can be postponed or elective. There are no significant differences in tumor size and lymph node metastasis between patients with delayed treatment ≤180 days and those without delayed treatment ( 41 ). However, a timely, safe, protective environment is recommended for patients with aggressive lymph node metastasis or suspected extrathyroidal metastasis ( 42 ).…”