Prognosis of papillary thyroid carcinoma in elderly patients after thyroid resection

Abstract

The size of the elderly population and the incidence of papillary thyroid carcinoma (PTC) in this group appear to be rapidly increasing, although published information based on more detailed older age groupings are lacking.This study aimed to determine the clinical features and outcomes of elderly patients in PTC.All consecutive patients who received surgery for PTC in our Department from 1978 to 2014 were included. We compared 3 patient groups: young (<65 years), older (65–75 years), and very old patients (>75 years). Total thyroidectomy was performed with lymph node (LN) dissection in most cases, and radioiodine therapy was administered as needed.A total of 3835 patients (3257 young patients, 450 older patients, and 128 very old patients) were identified. Very old patients were more likely to have advanced (III/IV) tumor, nodes, metastases (TNM) stage, greater tumor size, number of tumors, and extracapsular invasion compared with young and older patients. For the 2289 patients with LN dissection (60%), metastatic LNs were more frequent in the very old group (44%) than in the other groups (34% young and 33% older patients) (P = 0.01). Very old patients had more frequent distant metastases (5%) than the older (2%) and young groups (1%) (P < 0.001). The overall postoperative morbidity was not significantly different between the 3 age groups. Recurrence was documented in 202 (6.2%) young, 29 (6.4%) older, and 15 (11.7%) very old PTC patients (P = 0.04). The 5-year disease-free survival was 81.3% for very old, 92.9% for older, and 94.7% for young group (P < 0.001).Very old patients should be considered high-risk PTC patients and their therapeutic strategy may benefit from aggressive treatment.

Older Age Significantly Affects Mortality of Patients with Papillary Thyroid Carcinoma Only When They Have High‐Risk Features

“…In contrast, 105 out of 1116 patients (9.4%) of high-risk PTC died of thyroid carcinoma, and the prognosis of high-risk patients became significantly poorer with advancing age. These findings strongly suggest that advanced age can significantly affect the prognosis of only high-risk patients with PTC, which sharply contrasts with findings of previous studies [5,6]. The reason for this phenomenon remains unknown.…”

The role of prophylactic central compartment lymph node dissection in elderly patients with differentiated thyroid cancer: a multicentric study

“…Similar findings were reported by Niemann et al, who described a very aggressive pattern among patients with DTC aged under 25 years old and over 75 years old [32]. The former Authors supported a more aggressive surgical approach in DTC patients, suggesting to perform a lymph node dissection along with TT in all patients over 75 year old, especially if RAI ablation would supposed to be problematic and not administrated in this population [2]. In fact, postoperative RAI therapy is affected by several severe complications among elderly population, such as insomnia, osteoporosis and arrhythmias, and is generally administrated with a lower dose [33,34].…”

“…Very old patients have generally more aggressive clinicopathological features such as tumor size, extrathyroidal extension, T status and lymphnodes metastases, probably for the delayed diagnosis [2,14]. Chereau et al described a more aggressive tumor behavior in elderly patients with a higher recurrence rate of lymph node metastasis and a lower disease free survival compared to young patients [2]. In particular, the patients over 75 years old were affected by a 2-fold increased risk of recurrence compared with younger patients.…”

“…Elderly patients are conventionally defined as those with an age of 65 years or over [13]. Nevertheless, this definition is not worldwide accepted, thus several Authors have proposed a different cut-off at the age of 75 years old (very old patient) [2]. Recent papers described a dissimilar incidence of lymph node recurrence after DTC in aged people compared to young ones without reaching definitive conclusions [2,[12][13][14].…”

Subset analysis of the Japanese risk classification guidelines for papillary thyroid carcinoma

“…However, this study was not a single institution study, but an analysis on patients from the SEER database (1998 to 2012), indicating that patients who underwent various kinds of therapy were enrolled. Chareau et al published a single institution study demonstrating that very old patients (>75 years) showed a significantly poorer prognosis than younger patients, but they also showed that the incidence of high-risk patients was higher in very old patients [16]. We also investigated the prognosis of older patients in this series; however, we found that prognosis became poorer with age (60s, 70s, and 80s) for high-risk patients, but not for low-and intermediate-risk patients (data not shown).…”