Secular trends in the prognostic factors for papillary thyroid cancer

Abstract

Objective: With the recent increasing rates of screening for thyroid cancer, the cancers now tend to be smaller and less aggressive than those that are diagnosed when presented with symptoms, suggesting changes in the clinical validity of conventional prognostic factors for outcomes. We performed the retrospective study to identify the secular trends in the prognostic factors of thyroid cancer. Methods: We used medical records of 3147 patients diagnosed with papillary thyroid cancer (PTC) at the Seoul National University Hospital Thyroid Cancer Clinic between 1962 and 2009. Results: During the median 5.1-year follow-up, the overall recurrence rate was 13.3%, and male sex, tumor size, lymph node (LN) involvement, and extrathyroidal extension (ETE) were the significant prognostic factors for recurrence. Thyroid cancer-specific mortality was 1.4%, and the associated prognostic factors were older age, male sex, and LN involvement. For tumor recurrence, the hazard ratio (HR) for male sex decreased from 2.809 (95% CI, 1.497-5.269) in the pre-1989 period to 1.142 (95% CI, 0.736-1.772) in the post-1999 period. The pathologic characteristics, such as tumor size, LN involvement, and ETE, showed similar or increasing HRs over the time periods. For cancer-specific mortality, the HR for male sex decreased from 6.460 (95% CI, 1.714-24.348) in the pre-1990 period to 0.781 (95% CI, 0.083-7.379) in the post-1999 period. Conclusion: The risk for poor outcomes in PTC associated with male sex decreased over time; in contrast, the risk associated with pathologic characteristics remained the same or increased over time. These trends might be associated with recent changes in the characteristics of patients with thyroid cancer.

Postoperative biochemical remission of serum calcitonin is the best predictive factor for recurrence‐free survival of medullary thyroid cancer: a large‐scale retrospective analysis over 30 years

“…In recent years, the incidence of small thyroid cancer has increased globally mainly as a result of thyroid ultrasound screening . Consistent with this, changes over time in clinicopathological characteristics, outcomes and prognostic factors for differentiated thyroid cancer (DTC) have been reported. In a similar manner, increases in thyroid screening with ultrasound and measurement of serum calcitonin in subjects with thyroid nodules might have led to earlier detection of smaller MTCs.…”

“…LNs were also assessed based on positive or negative LNs, and nonresected LNs were categorized as negative LNs. Genetic tests for RET proto-oncogene mutation (exons 8,10,11,13,14,15,16), which was start to implement frequently since 2008, were performed in 172 patients, and family history of MTC or the presence of phenotypes of multiple endocrine neoplasia type 2 (MEN2) was obtained by reviewing the medical records for 310 patients. To evaluate changes in pathological findings over time, the patients were classified into four groups based on the year of diagnosis: This study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Institutional Review Board of SNU Hospital (IRB No.…”

Prognostic effects of TERT promoter mutations are enhanced by coexistence with BRAF or RAS mutations and strengthen the risk prediction by the ATA or TNM staging system in differentiated thyroid cancer patients

“…The overall median follow‐up duration was 4.8 years (interquartile range, 3.4‐10.6 years). The treatment protocol was the same as that in previous studies . The high‐risk group of the ATA staging system was defined by the presence of any of the following: macroscopic tumor invasion, incomplete tumor resection, and distant metastasis.…”

Increased Risk of Leukemia After Radioactive Iodine Therapy in Patients with Thyroid Cancer: A Nationwide, Population-Based Study in Korea

“…Third, we included all patients with thyroid cancer rather than only differentiated thyroid cancer, which might benefit from RAIT after thyroid surgery because the NHI database did not have information on histopathology. However, a recent Korean report regarding the histological classification of thyroid cancer showed that over 98% of new cases of thyroid cancer are patients with differentiated thyroid cancer (2,39); therefore, this limitation should have little effect on the study results.…”