Should Age at Diagnosis Be Included as an Additional Variable in the Risk of Recurrence Classification System in Patients with Differentiated Thyroid Cancer

Pitoia, Fabián; Jerkovich, Fernando; Smulever, Anabella; Brenta, Gabriela; Bueno, Fernanda; Cross, Graciela

doi:10.1159/000453450

Cited by 9 publications

(11 citation statements)

References 27 publications

(53 reference statements)

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“…We compared the clinic-pathologic features among these three groups of patients and found that elderly patients had higher proportion of male gender, advanced tumor grade, follicular subtype and advanced tumor stage (Summary Stage and AJCC 6 th Stage). These factors were all proved to be independent risk factors for prognosis in both univariate analysis and multivariable analysis which were consistent with previous reports 14 , 17 . Shah S et al found that there was a significantly larger percentage of excellent responders among young patients (age <55) than among old patients (age ≥ 55) 8 .…”

Section: Discussionsupporting

confidence: 91%

“…Age at diagnosis has long been identified as an established prognostic factor for TC patients 8 , 17 . The cutoff value for age to predict prognosis has been controversial 9 - 14 . In our present study, we applied two most common used cut-off value: 45 years and 65 years old to divide patients into 3 groups: 20-44 years, 45-64 years, and ≥ 65 years.…”

Section: Discussionmentioning

confidence: 99%

“…However, patients around 45-year old cannot be recognized as elderly. Some other studies used 65 years 13 or 60 years 14 . Little is known about the clinic-pathologic and prognostic factors in elder patients.…”

Section: Introductionmentioning

confidence: 99%

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Clinic-pathologic Features and Prognostic Analysis of Thyroid Cancer in the Older Adult: A SEER Based Study

Shi

Liu

et al. 2018

J. Cancer

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Purpose: Age at diagnosis has been identified as a major determinant of thyroid cancer-specific survival. But the cut-off value for age was controversial. The interaction among gender, age and histologic subtypes needed to be answered.Methods: We identified 59,892 thyroid cancer (TC) patients from the Surveillance, Epidemiology, and End Results (SEER) database. We divided the patients into the following three groups according to age: 20-44 years (young), 45-64 years (middle-aged), and ≥ 65 years (elderly). Logistic regression model was used to identify factors relating to prognosis in elderly patients. Multivariable Cox regression model identified potential prognostic factors. All statistical tests were two-sided.Results: Elderly patients had significantly worse prognosis than the other two groups, P=0.001. Elderly patients had higher proportion of male gender, advanced tumor grade, follicular subtype and advanced tumor stage. There was no survival difference for elderly patients to receive lobectomy and total thyroidectomy, P=0.852. Cox proportional hazards regression model showed that gender, marital status, histology, tumor grade, tumor size, TNM stage, surgery and radiotherapy were all independent prognostic factors in the multivariable analysis. Male patients with TC had worse prognosis than their female counterparts in differentiated tumor but not in undifferentiated tumor. There were more patients of larger tumor, advanced TNM stage and histologic subtypes in male patients.Conclusions: In conclusion, there were a series of factors contributing to the poor prognosis in elderly patients including clinic-pathologic factors and therapy selection. There was no survival difference for elderly patients to receive lobectomy and total thyroidectomy.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Clinic-pathologic Features and Prognostic Analysis of Thyroid Cancer in the Older Adult: A SEER Based Study

Shi

Liu

et al. 2018

J. Cancer

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“…A few studies have explored the age at diagnosis as a variable related to the RR in DTC patients. Our group analyzed the impact of age at the diagnosis of DTC on the frequency of structural incomplete response, considering the Modified Stratification System from ATA 2009 guidelines (Pitoia et al 2017). In this study, we did not find any age threshold that could distinguish an older group of patients with a higher risk for structural incomplete response neither at the initial response to treatment nor at the end of follow-up.…”

Section: Introductionmentioning

confidence: 84%

Dynamic risk assessment in patients with differentiated thyroid cancer

Pitoia

Jerkovich

2019

Endocrine-Related Cancer

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The stratification of patients with differentiated thyroid cancer based on their initial risk of recurrence, according to specific clinical, histopathological and perioperative data, is an important starting point for tailoring the follow-up during the first 1–2 years after initial therapy (surgery with or without radioiodine ablation). However, risk of recurrence re-stratification based on new clinical data that becomes available after considering the response to treatment (dynamic risk assessment) provides a more accurate prediction of the status at final follow-up and a more individualized approach. In this review, we summarized the available data regarding dynamic risk of recurrence and the suggested management of differentiated thyroid cancer patients according to the response to treatment. The use of this strategy is crucial to avoid overtreatment and intensive follow-up of the vast majority of patients who will have a very good prognosis and, on the other hand, focus therapeutic efforts on those patients who will have a worse prognosis. In the future, molecular biology analysis of the tumors and well-designed prospective studies will probably refine the risk of recurrence prediction.

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“…They suggested that incorporation of age in the ATA risk stratification would increase its power to predict response to therapy and mortality [ 49 ]. On the other hand, a few studies have not shown an important role for age in the estimation of risk of recurrence [ 50 ]. Pitoia et al retrospectively reviewed 268 patients with DTC (88.4% of them were ATA low- and intermediate-risk stages) with a median age at diagnosis of 45.9 years (range, 18-87 years) and found no impact of age on the probability of a structurally incomplete response at the initial evaluation and at last follow-up [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Course and Predictive Factors of Incomplete Response to Therapy in Low- and Intermediate-Risk Thyroid Cancer

Alzahrani

Moria

Mukhtar

et al. 2020

Journal of the Endocrine Society

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Context Controversy surrounds the extent and intensity of the management of the American Thyroid Association (ATA) intermediate and low risk patients with differentiated thyroid cancer (DTC). Understanding the natural history and factors that predict outcome is important for properly tailoring the management of those patients. Objective To study the natural course and predictive factors of incomplete response to therapy in low and intermediate risk DTC. Patients and Methods We studied a cohort of 506 consecutive patients (418 females [(82.6%) and 88 males (17.4%)] with low and intermediate risk with a median age of 35 years (IQR 27-46). We analyzed the natural course and the predictive factors of biochemically or structurally incomplete response. Results Of 506 patients studied, 297 (58.7%) patients were in low and 209 (41.3%) in intermediate risk groups. Over a median follow up of 102 months (IQR 66-130), 458 (90.5%) patients achieved an excellent response, 17 (3.4%) were in biochemically incomplete and 31 (6.1%) in a structurally incomplete status. In univariate and multivariate analyses, age (≥ 33 years) (P <0.0001, Odds ratio 1.06 (1.04-1.08) and lateral lymph node metastasis (LNM) (P < 0.0001, Odds ratio 3.2 (1.7-5.9) were strong predictive factors for biochemically and structurally incomplete response to therapy. Sex, tumor size, multifocality, extrathyroidal extension and lymphovascular invasion did not predict incomplete response to therapy. Conclusions Patients with low and intermediate risk DTC have favorable outcome. Age and lateral LMN are strong predictors of an incomplete response to therapy. This suggests that older patients and those with LMN should be managed and followed up more proactively than younger patients and those without LMN.

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Should Age at Diagnosis Be Included as an Additional Variable in the Risk of Recurrence Classification System in Patients with Differentiated Thyroid Cancer

Cited by 9 publications

References 27 publications

Clinic-pathologic Features and Prognostic Analysis of Thyroid Cancer in the Older Adult: A SEER Based Study

Clinic-pathologic Features and Prognostic Analysis of Thyroid Cancer in the Older Adult: A SEER Based Study

Dynamic risk assessment in patients with differentiated thyroid cancer

Course and Predictive Factors of Incomplete Response to Therapy in Low- and Intermediate-Risk Thyroid Cancer

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