The influence of nodule size on the aggressiveness of thyroid carcinoma varies with patient’s age

Meng, Chunlei; Wang, Wenlong; Zhang, Yuezhong; Li, Xinying

doi:10.21037/gs-20-747

Cited by 9 publications

(9 citation statements)

References 32 publications

(39 reference statements)

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“…Numerous studies have focused on the analysis of prognosis based on age stratification. Our previous research demonstrated that the effect of tumor size on the aggressiveness of PTC varied with the patient's age (23). Additionally, a study indicated that BRAF mutation was more common in PTC patients over 55 years old (24).…”

Section: Discussionmentioning

confidence: 98%

Can Cervical Lymph Node Metastasis Increase the Risk of Distant Metastasis in Papillary Thyroid Carcinoma?

et al. 2022

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BackgroundDistant metastasis (DM) is a rare event and has a negative effect on the prognosis for papillary thyroid carcinoma (PTC). The relationship between cervical lymph node metastasis and DM is complicated and unclear. This study aimed to evaluate the impact of N stage subclassification on different distant metastasis sites based on age stratification, especially for patients with papillary thyroid microcarcinoma.MethodsA total of 28,712 patient with PTC cases between 2010 and 2018 were extracted from the Surveillance, Epidemiology, and End Results database. Multivariable logistic regression analysis was utilized to adjust for confounding variables. Risk stratification, including positive lymph node number and lymph node ratio, was established by receiver operating characteristic curves to help predict DM.ResultsLung was the most common metastatic site regardless of N0, N1a disease, or N1b disease. As the N stage increased, the higher the rate of DM identified. After age stratification, only N1b disease significantly increased the risk of lung metastasis (LM; odds ratio, OR = 20.45, P < 0.001) rather than bone metastasis (BM; OR = 3.46, P > 0.05) in younger patients. However, in older patients, N1b disease significantly increased the risk of both LM (OR = 4.10, P < 0.001) and BM (OR = 2.65, P = 0.007). In patients with papillary thyroid microcarcinoma (PTMC), N1a disease did not increase the risk of DM, LM, and BM compared with N0 disease (P > 0.05). Furthermore, combined N stage with risk stratification has well performance in predicting DM (area under the curve, AUC = 0.761). Similar results were shown in PTC patients with LM (AUC = 0.770) and BM (AUC = 0.729).ConclusionOverall, the incidence of DM significantly increased with the progress of N disease after age stratification. N1a disease did not increase the risk of DM in PTMC patients, regardless of LM or BM. Combined N stage with risk stratification may be beneficial for DM prediction.

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Section: Discussionmentioning

confidence: 98%

Can Cervical Lymph Node Metastasis Increase the Risk of Distant Metastasis in Papillary Thyroid Carcinoma?

et al. 2022

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“…In a recently done study, they did find that large nodule size is significantly related to a more aggressive thyroid cancer indicating unfavorable events. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

The yield of thyroid fine-needle aspiration in a primary care setting in Riyadh, Saudi Arabia

Khenizan

Ruhaiyem

Hussain

2022

Journal of Family Medicine and Primary Care

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A BSTRACT Background: Thyroid cancer is the second most common cancer among women. This study was conducted to assess the yield of fine-needle aspiration (FNA) cytology of thyroid nodules in a primary care setting in Riyadh, Saudi Arabia. Materials and Methods: In this retrospective cohort study, primary care patients of both genders with thyroid nodules who underwent FNA above the age of 18 years were enrolled. Patients with a prior history of cancer were excluded. The data was collected from the histopathology reports of FNAs done for thyroid nodules from January 01, 2002 to July 31, 2018. Results: We enrolled 263 patients in this study. The mean age of the study population was 41.3 years old (Standard deviation (SD) ± 10.1), 81.7% were females and 18.3% were males. The rate of abnormal ultrasound (US) was 16%. The mean thyroid-stimulating hormone (TSH) level was 2.3 mU/L (SD ± 5.9). Post-thyroidectomy, 17.5% had carcinoma on pathology reports. Among those who were diagnosed with thyroid cancer, 76.2% had papillary thyroid cancer, 21.4% had follicular thyroid cancer, and 2.4% had medullary thyroid cancer. The mean age for cancer diagnosis was 40 years old (SD ± 8). There was no significant association between FNA findings (benign/malignant) and age, gender, history of smoking, size of the nodule, or TSH level. Conclusion: Thorough investigations including FNA should be considered for patients presenting with suspicious thyroid nodules, regardless of their size or the patients’ gender. Access to such investigations and referrals to specialists should be available for primary care physicians.

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“…Moreover, a recent study based on two larger cohorts demonstrated that lymph node involvement was associated with compromised survival in young patients ( 18 ). Also, our previous study found that a large nodule size significantly increased the risk of unfavorable events in younger patients ( 19 ). The abovementioned results suggest that it is inappropriate to classify patients younger than 55 years without metastatic disease into uniform stage, and that stage II DTC in older patients and stage II DTC in younger patients are not equal in overall survival.…”

Section: Introductionmentioning

confidence: 88%

A critical analysis of the current TNM classification for differentiated thyroid carcinoma in young patients: Time for a change?

Wang¹,

Bai²,

Li³

2022

Front. Endocrinol.

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BackgroundThe current TNM classification that simply classifies differentiated thyroid carcinoma (DTC) patients younger than 55 years into stage I and stage II based on the presence or absence of distant metastases has been questioned. In this study, we reexamined the impact of T status and N status on prognosis and then developed a new prediction model to improve the predictability of cancer-specific survival (CSS) in young patients.Materials and methodsKaplan–Meier method was applied to calculate the CSS. Multivariable Cox proportional hazards models were used to assess the impact of T status and N status on CSS after adjustment for known covariates. The area under the receiver operating characteristic curve (AUC), C-index, Bayesian information criterion (BIC), and Akaike information criterion (AIC) were calculated to compare model performance.ResultsA total of 9,242 DTC patients younger than 55 years were enrolled in the study. After adjusting for gender, age at diagnosis, race, pathology subtype, N stage, and M stage, T3 disease [hazard ratio (HR): 3.78, P = 0.006] and T4 disease (HR: 7.96, P < 0.001) remain independent predictors of CSS. Similarly, the 10-year CSS rate of N1b disease (HR: 3.78, P < 0.001) was significantly higher than that of N0 disease after adjustment. Moreover, Kaplan–Meier survival analysis showed that the 10-year CSS of stage II disease in younger patients with DTC showed a sharp decrease compared with that in older patients with DTC (74.47% vs. 98.43%, P < 0.001). Furthermore, a modified TNM staging system based on significantly prognostic T stage and N stage was established, which showed better performance than the current TNM staging system (P < 0.05). The new prediction model is also applicable to papillary thyroid carcinoma patients and follicular thyroid carcinoma patients.ConclusionsThis is the first study to question the rationality of the current TNM staging system for patients younger than 55 years and successfully develop a new prognostic model, which improves prognostic stratification and guides individualized management.

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The influence of nodule size on the aggressiveness of thyroid carcinoma varies with patient’s age

Cited by 9 publications

References 32 publications

Can Cervical Lymph Node Metastasis Increase the Risk of Distant Metastasis in Papillary Thyroid Carcinoma?

Can Cervical Lymph Node Metastasis Increase the Risk of Distant Metastasis in Papillary Thyroid Carcinoma?

The yield of thyroid fine-needle aspiration in a primary care setting in Riyadh, Saudi Arabia

A critical analysis of the current TNM classification for differentiated thyroid carcinoma in young patients: Time for a change?

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