The age threshold of the 8th edition AJCC classification is useful for indicating patients with aggressive papillary thyroid cancer in clinical practice

Abstract

Background Papillary thyroid cancer (PTC) is unique among cancers in that patient age is a consideration in staging. One of the most important modifications in the 8th Edition of the American Joint Committee on Cancer (AJCC) classification is to increase the age cut off for risk stratification in PTC from 45 to 55 years. However, whether this cut off is useful in clinical practice remains controversial. In the present study, we assessed how well this new age threshold stratifies patients with aggressive PTC. Methods We retrospectively analyzed the clinicopathological features and overall survival rate of patients with PTC admitted to and surgically treated at a single surgical center. The study protocol was divided into two series. In each series all patients (n = 523) were divided in 2 groups according to age cut off. In the first series (cut off 45) patients < 45 (n = 193) vs. ≥45 (n = 330) were compared, and in the second series (cut off 55) patients < 55 (n = 306) vs. ≥55 (n = 217) were compared. Results The rate of the prevalence of locally advanced disease (pT3 and pT4) was significantly higher in the patients above 55 years old than in those below 55 years old (p = 0.013). No significant differences were found for this parameter in series with cut off point 45 years old. A significantly higher risk of locally advanced disease T3 + T4 (OR = 4.87) and presence of LNM (N1) (OR = 3.78) was observed in ≥45 years old group (p = 0.021 and p < 0.0001, respectively). More expressive results were found for the patients ≥55 years old group, where the risk of locally advanced disease (T3 + T4) was higher (OR = 5.21) and LNM presence was OR = 4.76 (p < 0.001 and p < 0.0001, respectively). None of the patients below 55 years old showed distant metastasis, but 19 patients above 55 years old showed M1 (p < 0.0001). In older patients group (≥55 years old) we observed deaths related thyroid cancer in 11 individuals. Conclusions The age cut off of 55 years old for risk stratification proposed by the 8th Edition of AJCC effectively stratifies PTC patients with a poor prognosis, indicating it is likely to be useful in clinical practice.

Survival rates and prognostic factors of thyroid cancer: A retrospective cohort study

“…In most studies, age has been reported as one of the most important and effective risk factors for the survival of the disease in patients with thyroid cancer (17).…”

The Correlation of Age with Prognosis of Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Thyroid Nodules

“… 34 It was supported by our results. 35 Studies have assessed that a higher age cutoff rather than a previously estimated 45 years old improves the accuracy of the prognostic system and therefore should decrease the overtreatment rate of patients. 35 In the present study, we found that younger age of the patient with AUS/FLUS diagnosis was an independent predictor for malignancy.…”

“… 35 Studies have assessed that a higher age cutoff rather than a previously estimated 45 years old improves the accuracy of the prognostic system and therefore should decrease the overtreatment rate of patients. 35 In the present study, we found that younger age of the patient with AUS/FLUS diagnosis was an independent predictor for malignancy. We observed a statistically significant difference in the ROM between the patients below 55 years old and those 55 years old and older.…”

Hobnail Papillary Thyroid Carcinoma, A Systematic Review and Meta-Analysis

“…In patients with classic PTC, mean age at diagnosis was found to be 48 years, whereas in our cohort of HPTC the mean age was higher, i.e., 51.3 years [ 48 ]. Older age is a known negative predictive factor for survival, and this was also confirmed in the case of HPTC, with older age correlating with reduced survival [ 54 , 55 ].…”