1
|
Wang D, Yang Y, He Y, Yang H, Yang L. Natural History and Prognostic Model of Untreated Papillary Thyroid Cancer: A SEER Database Analysis. Cancer Control 2024; 31:10732748241253956. [PMID: 38756002 PMCID: PMC11102674 DOI: 10.1177/10732748241253956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 03/27/2024] [Accepted: 04/24/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE This investigation leveraged the SEER database to delve into the progression patterns of PTC when left untreated. Furthermore, it aimed to devise and authenticate a nomogram for prognosis prediction for such patients. METHODS We extracted data from the SEER database, focusing on PTC-diagnosed individuals from 2004-2020. To discern disease progression intervals, median survival times across stages were gauged, and the disease progression time was estimated by subtracting the median survival time of a more severe stage from its preceding stage. Prognostic determinants in the training set were pinpointed using both univariate and multivariate Cox regression. Using these determinants, a prognostic nomogram was crafted. RESULTS In untreated PTC patients, those in stages I and II had a favorable prognosis, with 10-year overall survival rates of 86.34% and 66.03%, respectively. Patients in stages III and IV had a relatively poorer prognosis. The median survival time of stage III, stage IVA, stage IVB and stage IVC patients was 108months, 43 months, 20 months and 8 months, respectively. The deduced progression intervals from stages III-IVC were 65, 23, and 12 months. In the training set, age, tumor stage, gender, and marital status were identified as independent risk factors influencing the prognosis of untreated PTC, and a nomogram was constructed using these variables. CONCLUSION In the absence of treatment intervention, early-stage PTC progressed slowly with an overall favorable prognosis. However, in mid to advanced-stage PTC, as tumor stage increased, disease progression accelerated, and prognosis gradually worsened. Age, tumor stage, marital status, and gender were independent risk factors influencing the prognosis of untreated PTC, and the nomogram based on these factors demonstrated good prognostic capability.
Collapse
Affiliation(s)
- Dasong Wang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, China
| | - Yan Yang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, China
| | - Yu He
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, China
| | - Hongwei Yang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, China
| | - Lei Yang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, China
| |
Collapse
|
2
|
Rezaei F, Mazidimoradi A, Pasokh Z, Dehghani SP, Allahqoli L, Salehiniya H. Temporal trends of thyroid cancer between 2010 and 2019 in Asian countries by geographical region and SDI, comparison with global data. Aging Med (Milton) 2023; 6:386-426. [PMID: 38239716 PMCID: PMC10792336 DOI: 10.1002/agm2.12277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024] Open
Abstract
Objective This study aims to describe temporal trends of thyroid cancer (ThC) from 2010 to 2019, in Asian countries by geographical region and sociodemographic index, compared with global data. Method Annual case data and age-standardized rates (ASRs) of epidemiological indicators of ThC cancer data were collected from the 2019 Global Burden of Disease (GBD) study from 2010 to 2019 in 49 countries and territories in Asia. The relative difference (%) between years was used to show comparative variations of ASRs for the indicators studied. The female/male ratio was calculated by dividing female ASRs by male ASRs. Also, these rates were compared between the age group ≥70 years old and younger age groups. Results In 2019, more than 50% of ThC cases and deaths occurred in Asian countries. A total of 53% of ThC patients lived in Asia and more than 60% of the global burden of ThC was imposed on Asian countries. From 2010 to 2019, incidences, deaths, prevalence cases, and DALYs number of ThC cancer increased over 1.28-, 1.26-, 1.3-, and 1.2-fold, in Asia, respectively. During this period, the age-standardized incidence rate (ASIR) and the age-standardized prevalence rate (ASPR) of ThC cancer increased by 5% and 8%, respectively, while the age-standardized death rate (ASDR) and the age-standardized DALYs rate (DALYs ASR) of ThC cancer decreased by 6% and 4%, respectively. These trends are different from what happens in other continents. In 2019, age-specific incidence, death, prevalence, and DALY cases of ThC cancer were peaking at 50-54, 75-79, 50-54, and 55-59 years, respectively. In 2019, the highest ASIR and ASPR of ThC cancer was observed in high-income Asia Pacific countries and the highest ASDR and DALYs ASR in Southeast Asia countries. Only high-income Asia Pacific countries experienced a decreasing trend in ASIR and ASPR from 2010 to 2019. ASDR and DALYs ASR have the highest decreasing trend in high-income Asia Pacific. In 2019, among high SDI Asian countries, the Republic of Korea had the highest ASIR and ASPR, and Brunei Darussalam had the highest ASDR and DALYs ASR. The highest ASIR, ASDR, ASPR, and DALY ASR of ThC cancer was found in Lebanon and Malaysia (high-middle SDIs), Vietnam (middle SDIs), and Cambodia and Palestine (low-middle SDIs). Among low SDI Asian countries, Pakistan had the highest ASIR, ASDR, ASPR, and DALY ASR of ThC cancer. All indicators for most countries were higher in women than men. Conclusion More than half of the burden of thyroid cancer is imposed on the residents of the Asian continent. Although the incidence and prevalence of this cancer in Asian countries is lower than that of the world, America, and Europe, the highest rate of death from thyroid cancer occurs in Asia and they witness the highest burden of the disease. Therefore, it seems that implementing early detection strategies and increasing access to treatment facilities in Asia is one of the necessities of thyroid cancer control in its residents.
Collapse
Affiliation(s)
- Fatemeh Rezaei
- Research Center for Social Determinants of HealthJahrom University of Medical SciencesJahromIran
| | | | - Zahra Pasokh
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | | | - Leila Allahqoli
- Midwifery DepartmentMinistry of Health and Medical EducationTehranIran
| | - Hamid Salehiniya
- Department of Epidemiology and Biostatistics, School of Health, Social Determinants of Health Research CenterBirjand University of Medical SciencesBirjandIran
| |
Collapse
|
3
|
Wang J, Zhanghuang C, Jin L, Zhang Z, Tan X, Mi T, Liu J, Li M, Wu X, Tian X, He D. Development and validation of a nomogram to predict cancer-specific survival in elderly patients with papillary thyroid carcinoma: a population-based study. BMC Geriatr 2022; 22:736. [PMID: 36076163 PMCID: PMC9454205 DOI: 10.1186/s12877-022-03430-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/29/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Thyroid carcinoma (TC) is the most common endocrine tumor in the human body. Papillary thyroid carcinoma (PTC) accounts for more than 80% of thyroid cancers. Accurate prediction of elderly PTC can help reduce the mortality of patients. We aimed to construct a nomogram predicting cancer-specific survival (CSS) in elderly patients with PTC. Methods Patient information was downloaded from the Surveillance, Epidemiology, and End Results (SEER) program. Univariate and multivariate Cox regression models were used to screen the independent risk factors for patients with PTC. The nomogram of elderly patients with PTC was constructed based on the multivariate Cox regression model. We used the concordance index (C-index), the area under the receiver operating characteristic curve (AUC) and the calibration curve to test the accuracy and discrimination of the prediction model. Decision curve analysis (DCA) was used to test the clinical value of the model. Results A total of 14,138 elderly patients with PTC were included in this study. Patients from 2004 to 2015 were randomly divided into a training set (N = 7379) and a validation set (N = 3141), and data from 2016 to 2018 were divided into an external validation set (N = 3618). Proportional sub-distribution hazard model showed that age, sex, tumor size, histological grade, TNM stage, surgery and chemotherapy were independent risk factors for prognosis. In the training set, validation set and external validation set, the C-index was 0.87(95%CI: 0.852–0.888), 0.891(95%CI: 0.866–0.916) and 0.931(95%CI:0.894–0.968), respectively, indicating that the nomogram had good discrimination. Calibration curves and AUC suggest that the prediction model has good discrimination and accuracy. Conclusions We constructed a new nomogram to predict CSS in elderly patients with PTC. Internal cross-validation and external validation indicate that the model has good discrimination and accuracy. The predictive model can help doctors and patients make clinical decisions.
Collapse
Affiliation(s)
- Jinkui Wang
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Chenghao Zhanghuang
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Department of Urology, Kunming Children's Hospital, Yunnan Provincial Key Research Laboratory of Pediatric Major Diseases, Kunming, 650228, China
| | - Liming Jin
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhaoxia Zhang
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xiaojun Tan
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Tao Mi
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jiayan Liu
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Mujie Li
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xin Wu
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xiaomao Tian
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Dawei He
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
| |
Collapse
|
4
|
Díez JJ, Anda E, Alcazar V, Isidro ML, Familiar C, Paja M, Rojas Marcos P, Pérez-Corral B, Navarro E, Romero-Lluch AR, Oleaga A, Pamplona MJ, Fernández-García JC, Megía A, Manjón L, Sánchez-Ragnarsson C, Iglesias P, Sastre J. Differentiated thyroid carcinoma in the elderly: influence of age on disease-free and overall survival. Endocrine 2022; 77:121-133. [PMID: 35585463 DOI: 10.1007/s12020-022-03059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE We investigated whether age at diagnosis of differentiated thyroid carcinoma (DTC) may be a risk factor for structural disease and mortality after primary treatment in aging patients. METHODS A multicenter, retrospective analysis including patients older than 60 years at DCT diagnosis was designed. All subjects were treated by surgery with or without radioiodine adjuvant therapy and had a minimum follow-up of one year. We compared elderly patients (group 1, 60-74 years) with very old patients (group 2, ≥75 years). RESULTS The study involved 1668 patients (74.3% women, median age 67 years, 87.6% papillary thyroid cancer, 73.3% treated with radioiodine), including 1397 in group 1 and 271 in group 2. Patients in group 2 had larger tumor size (1.8 [0.8-3.0] vs 1.5 [0.7-2.8] cm; P = 0.005), higher proportions of tumors with vascular invasion (23.8 vs 16.4%; P = 0.006), and lower proportion of lymphocytic thyroiditis (18.6 vs 24.9%; P = 0.013) than subjects in group 1. Kaplan-Meier survival analysis showed that patients in group 2 had significantly lower structural disease-free survival (DFS) and overall survival (OS) than patients in group 1 (P = 0.035 and <0.001, respectively). In multivariate Cox regression analysis, age was a risk factor significantly associated with OS. However, age was significantly associated with DFS in unadjusted analysis and in analysis adjusted by gender and risk classification variables, but not when pathological and therapy-related variables were introduced in the model. On the other hand, patients who received radioiodine had worse DFS (P < 0.001) compared to those who did not. CONCLUSION Although age is a conditioning factor for OS, very old patients do not have a greater risk of developing structural disease throughout the follow-up than elderly patients with DTC.
Collapse
Affiliation(s)
- Juan J Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain.
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Emma Anda
- Department of Endocrinology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Victoria Alcazar
- Department of Endocrinology, Hospital Severo Ochoa, Leganés, Spain
| | - María L Isidro
- Department of Endocrinology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Cristina Familiar
- Department of Endocrinology, Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel Paja
- Department of Endocrinology, Hospital Universitario de Basurto, Bilbao, Spain
- Department of Medicine, Universidad del País Vasco, Leioa, Spain
| | | | - Begoña Pérez-Corral
- Department of Endocrinology, Complejo Asistencial Universitario de León, León, Spain
| | - Elena Navarro
- Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana R Romero-Lluch
- Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Amelia Oleaga
- Department of Endocrinology, Hospital Universitario de Basurto, Bilbao, Spain
- Department of Medicine, Universidad del País Vasco, Leioa, Spain
| | - María J Pamplona
- Department of Endocrinology, Hospital Royo Villanova, Zaragoza, Spain
| | - José C Fernández-García
- Department of Endocrinology, Hospital Regional Universitario de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Ana Megía
- Department of Endocrinology, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Ciberdem, Tarragona, Spain
| | - Laura Manjón
- Department of Endocrinology, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Cecilia Sánchez-Ragnarsson
- Department of Endocrinology, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Julia Sastre
- Department of Endocrinology, Complejo Hospitalario de Toledo, Toledo, Spain
| |
Collapse
|
5
|
Sahli ZT, Canner JK, Zeiger MA, Mathur A. Association between age and disease specific mortality in medullary thyroid cancer. Am J Surg 2020; 221:478-484. [PMID: 33010878 DOI: 10.1016/j.amjsurg.2020.09.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/07/2020] [Accepted: 09/20/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the association between age and disease specific mortality (DSM) among adults diagnosed with medullary thyroid cancer (MTC). METHOD Surveillance, Epidemiology, and End Results (SEER-18) was used to analyze adult MTC patients stratified by age (18-64, 65-79, ≥80 years). Associations between patient demographics, tumor size, nodal status, metastatic disease, and extent of surgery on DSM was assessed with multivariable Cox regression. RESULTS Among 1457 patients with MTC, 1008 (69.2%) were younger adults, 371 (25.5%) older adults, and 78 (5.4%) were super-elderly. A significantly higher proportion of older adults and super-elderly had less than the recommended operation for MTC. On multivariable analysis, older adults and super-elderly were 2.9 and 6.7 times more likely to have an increased DSM (HR:2.91, 95% CI: 1.83-4.63; p < 0.001 and HR: 6.70, 95%CI: 3.69-12.20; p < 0.001). Extent of surgery or lymphadenectomy did not affect DSM. CONCLUSIONS Increased age is an independent predictor of DSM in patients with MTC.
Collapse
Affiliation(s)
- Zeyad T Sahli
- Department of Surgery, The University of Virginia Health System, P.O. Box 800681, Charlottesville, VA, 22908, USA
| | - Joseph K Canner
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD, 21287, USA
| | - Martha A Zeiger
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Aarti Mathur
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD, 21287, USA.
| |
Collapse
|
6
|
Marina M, Serra MF, Aldigeri R, Ceresini G. Incidental versus clinically diagnosed differentiated thyroid cancer in both adult and elderly subjects: histological characteristics and follow-up in a retrospective analysis from a single institution. Endocrine 2020; 68:584-591. [PMID: 31970586 DOI: 10.1007/s12020-020-02200-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/13/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Most thyroid cancer are incidentally diagnosed. However, little is known on the different modalities of incidental diagnosis in adult versus older patients. METHODS We retrospectively analyzed data from 440 patients consecutively diagnosed with differentiated thyroid cancer (DTC) in a single institution. Modalities of diagnosis were categorized as follows: (A) clinically diagnosed, nonincidental cases; (B) incidental during carotid power-duplex (CPD); (C) incidental during neck imaging other than carotid power-duplex; (D) incidental during imaging workup of thyroid dysfunction or at histological examination after thyroidectomy for benign lesions. Demographics, histology and follow-up were compared between adult (<65 years) and older (≥65 years) patients according to the different modalities of diagnosis. RESULTS A total of 363 and 67 cases were recorded in adult and older patients, respectively with incidental proportions of 79% and 85%, respectively. A P < 0.001 significant difference in the modality of diagnosis was found between adult and older subjects, the latter presenting with a higher prevalence of Group B. In the nonincidental group, papillary histotype, larger size, and extrathyroidal invasion were more frequently observed in older subjects. Disease-free survival was comparable between adult and older subjects in the incidental cases, whereas it was reduced, though not significantly, in older subjects. CONCLUSION Incidental cases of DTC are more frequently diagnosed in the old subjects and are mainly due to CPD. Disease-free survival is comparable between adult and older subjects in both incidental and nonincidental cases, although it may be slightly reduced in nonincidentally diagnosed older patients.
Collapse
Affiliation(s)
- Michela Marina
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Maria Francesca Serra
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Raffaella Aldigeri
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Graziano Ceresini
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy.
| |
Collapse
|
7
|
Duskin-Bitan H, Leibner A, Amitai O, Diker-Cohen T, Hirsch D, Benbassat C, Shimon I, Robenshtok E. Bone-Marrow Suppression in Elderly Patients Following Empiric Radioiodine Therapy: Real-Life Data. Thyroid 2019; 29:683-691. [PMID: 31084551 DOI: 10.1089/thy.2018.0423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Elderly patients with differentiated thyroid cancer (DTC) tend to have more advanced disease at presentation, for which high activities of radioiodine (RAI) are often recommended. However, the 2015 American Thyroid Association guidelines recommend that empirically administered activities of RAI >150 mCi should be avoided in patients >70 years of age, based on calculated bone-marrow exposure according to two dosimetry-based studies. This study aimed to evaluate the effect of RAI treatment on bone-marrow function in elderly DTC patients. Methods: DTC patients ≥70 years of age who received RAI treatment and on whom a complete blood count was performed before and after treatment were included. Blood counts within one year before RAI and one year following treatment were compared in order to assess for marrow suppression. The impact of demographic, clinical, and laboratory variables on complete blood count were assessed. Results: One hundred fifty-three treatments in 122 patients met inclusion criteria, with a mean patient age of 76 ± 4.3 years, and 75% were women. High-risk features at presentation included T4 disease in 17%, lymph node metastases in 34%, and distant metastases in 14%. Mean RAI activity was 136.8 ± 48 mCi (82% ≥ 100 mCi, 66% ≥ 150 mCi). Of 153 RAI treatments analyzed, 114 (74%) were first treatments, 28 (18%) second treatments, seven (5%) third treatments, and four (3%) fourth treatments. At 0-3 months after RAI treatment, there was a statistically significant decrease in platelets (238 ± 66 vs. 216 ± 69 × 109/L, 10% decrease; p < 0.001), white blood cells (WBC; 6.9 ± 2 vs. 6.1 ± 1.9 × 109/L, 13% decrease; p < 0.001), and hemoglobin (Hb) in women (12.8 ± 1.1 vs. 12.4 ± 1.1 g/dL, 3% decrease; p = 0.01). Mean platelets, WBC, Hb in women, and lymphocytes remained decreased (but within the reference range) one year after treatment. Subgroup analysis demonstrated platelet suppression only with activities ≥100 mCi, and WBC and Hb suppression only with activities ≥150 mCi, with mean values within the reference ranges. There were no clinically significant cytopenia events during follow-up. Conclusions: Empiric RAI treatment in elderly patients causes mild bone-marrow suppression, with little clinical significance. Activities of 150-200 mCi can be safely used when indicated.
Collapse
Affiliation(s)
- Hadar Duskin-Bitan
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Anat Leibner
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Oren Amitai
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Talia Diker-Cohen
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Dania Hirsch
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Carlos Benbassat
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
- 3 Endocrine Institute, Assaf Harofeh Medical Center, Zrifin, Israel
| | - Ilan Shimon
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Eyal Robenshtok
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| |
Collapse
|
8
|
Gambardella C, Patrone R, Di Capua F, Offi C, Mauriello C, Clarizia G, Andretta C, Polistena A, Sanguinetti A, Calò P, Docimo G, Avenia N, Conzo G. The role of prophylactic central compartment lymph node dissection in elderly patients with differentiated thyroid cancer: a multicentric study. BMC Surg 2019; 18:110. [PMID: 31074400 PMCID: PMC7402571 DOI: 10.1186/s12893-018-0433-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/29/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Prophylactic central neck lymph-nodes dissection is still a topic of major debate in Literature. There is a lack of randomized controlled trials proving advantages in its application in terms of overall survival and local recurrence. Due to the recent rapid increase of elderly population, differentiated tumor carcinoma diagnosis increased in patients over 65 years old. The aim of this study was to compare recurrence rate, complications rate and histological features of tumors in elderly population. METHODS A retrospective study was carried out collecting data from 371 patients with differentiated thyroid cancer without clinical evidence of lymph-nodes involvement in three Italian referral centers from 2005 to 2015. All patients were aged ≥ 65 years and were divided in two groups based on the performed surgery (total thyroidectomy alone or associated with central lymph-nodes dissection). Moreover, patients were stratified according to the age between 65 and 74 years old and over 75 years old. RESULTS Total thyroidectomy alone was performed in 184 patients (group A) and total thyroidectomy with prophylactic central neck dissection was performed in 187 cases (group B). There was a statistically significant difference in complications between the groups in terms of neck hematoma (0.5% group A vs 3.7% group B), temporary hypoparathyroidism (11.4% group A vs 21.4% group B), and temporary unilateral recurrent nerve injury (1.5% group A vs 6.4% group B). Lymph nodes recurrence rate was 9.2% in group A and 8.5% in group B, with no statistically significant difference. There was a statistically significant difference in patients over 75 years old in terms of temporary hypoparathyroidism (24% group A vs 11% group B), permanent hypoparathyroidism (2,7% group A vs 0,3% group B) and recurrent nerve injury (9,5% group A vs 2% group B). CONCLUSIONS The role of prophylactic central neck dissection is still controversial, especially in elderly patients, and an aggressive surgical approach should be carefully evaluated. The Authors reported a similar low recurrence rate between total thyroidectomy and total thyroidectomy associated with prophylactic central neck dissection, with increased postoperative complications in the lymphadenectomy group and in patients over 75 years old, advocating a tailored surgical approach in elderly population.
Collapse
Affiliation(s)
- Claudio Gambardella
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Renato Patrone
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Francesco Di Capua
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Chiara Offi
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Claudio Mauriello
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Guglielmo Clarizia
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Claudia Andretta
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Andrea Polistena
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Alessandro Sanguinetti
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Pietrogiorgio Calò
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Giovanni Docimo
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Nicola Avenia
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Giovanni Conzo
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| |
Collapse
|
9
|
|
10
|
Sahli ZT, Zhou S, Najjar O, Onasanya O, Segev D, Massie A, Zeiger MA, Mathur A. Octogenarians have worse clinical outcomes after thyroidectomy. Am J Surg 2018; 216:1171-1176. [PMID: 29729944 DOI: 10.1016/j.amjsurg.2018.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/28/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The rising proportion of older adults in the US population coupled with an increased prevalence of nodular thyroid disease will result in more thyroidectomies being performed. The aim of this study is to evaluate the clinical outcomes among older adults (age ≥65) undergoing thyroidectomy compared to younger adults (18-64). METHODS This was a population-based study of adult thyroidectomy patients using the Premier Healthcare Database, 2005-2014. Discharge status, hospital length of stay (LOS), morbidity, and total patient charge were compared between younger adults and older adults in three different age groups: ≥65, ≥70, and ≥80 years old. RESULTS Among 75,141 thyroidectomy patients, 15,805 (21.0%) patients were ≥65 years, 8834 (11.8%) were ≥70 years, and 1613 (2.2%) were ≥80 years. Patients ≥80 years were 2.6 times (aOR:2.58, 95%CI: 1.72-3.86; p < 0.001) more likely to be discharged to a home health organization than to be discharged to their residence and 1.6 times (aOR:1.61, 95%CI: 1.30-2.00; p < 0.001) more likely to have at least one complication. CONCLUSIONS Age ≥80 is an independent predictor of worse clinical outcomes after thyroidectomy.
Collapse
Affiliation(s)
- Zeyad T Sahli
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Sheng Zhou
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Omar Najjar
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Oluwadamilola Onasanya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Dorry Segev
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Allan Massie
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Martha A Zeiger
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Aarti Mathur
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| |
Collapse
|
11
|
Inversini D, Morlacchi A, Melita G, Del Ferraro S, Boeri C, Portinari M, Cancellieri A, Frattini F, Rizzo AG, Dionigi G. Thyroidectomy in elderly patients aged ≥70 years. Gland Surg 2017; 6:587-590. [PMID: 29142852 DOI: 10.21037/gs.2017.10.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Worldwide, the indications for thyroid surgery have been continuously extended among elderly patients in the last 20 years. The balance between treatment indication and surgical risk is certainly an interesting topic for every thyroid surgeon. This paper is a review of recent literature from January 2005 up to April 2017. We analyzed three principal subjects: indications for surgical treatment, medical complications and surgical complications. We can summarize the conclusions of our analysis, stating that age could not be considered as an absolute factor, but in relation to the comorbidities and the general clinical condition of the patient. Special risk indices dedicated to geriatric patients could be very useful in order to facilitate the decision-making process; however, relying on the current knowledge, we could state that there is value in providing surgery to geriatric patients in highly specialized and high-volume centers, where access to technology and its systematic use, coupled with surgeons' experience, could certainly avail the geriatric patient management.
Collapse
Affiliation(s)
- Davide Inversini
- ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese 21100, Italy
| | - Andrea Morlacchi
- ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese 21100, Italy
| | - Giuseppinella Melita
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood G. Barresi, University Hospital Policlinico G. Martino, University of Messina, Messina 98125, Italy
| | - Simona Del Ferraro
- ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese 21100, Italy
| | - Carlo Boeri
- ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese 21100, Italy
| | - Mattia Portinari
- Department of Surgery, S. Anna University Hospital, Ferrara, Italy.,Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Antonino Cancellieri
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood G. Barresi, University Hospital Policlinico G. Martino, University of Messina, Messina 98125, Italy
| | - Francesco Frattini
- ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese 21100, Italy
| | - Antonio Giacomo Rizzo
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood G. Barresi, University Hospital Policlinico G. Martino, University of Messina, Messina 98125, Italy
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood G. Barresi, University Hospital Policlinico G. Martino, University of Messina, Messina 98125, Italy
| |
Collapse
|
12
|
Dellal FD, Özdemir D, Tam AA, Baser H, Tatli Dogan H, Parlak O, Ersoy R, Cakir B. Clinicopathological features of thyroid cancer in the elderly compared to younger counterparts: single-center experience. J Endocrinol Invest 2017; 40:471-479. [PMID: 27885512 DOI: 10.1007/s40618-016-0577-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/02/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE The incidence of thyroid cancer is increased in elderly patients. It tends to be larger and have more aggressive characteristics in these patients. Our aim was to compare features of thyroid carcinoma in geriatric and non-geriatric patients. METHODS In total, 933 patients with thyroid cancer were retrospectively reviewed. Thyroid functions, ultrasonography features of malignant nodules, cytological and histopathological findings and the rates of recurrence and persistence were compared in patients ≥65 and <65 years old. RESULTS There were 153 malignant foci in 109 (11.7%) patients ≥65 and 1185 malignant foci in 824 (88.3%) patients <65 years old. Mean nodule diameter was significantly higher in geriatric patients (p = 0.008). Most of the ultrasonographical features of malignant nodules were similar in two groups. Hypoechoic halo was observed in 16.4 and 28.6% of malignant nodules in geriatric and non-geriatric group, respectively (p = 0.034). There was no significant difference in cytological diagnosis. Histopathologically, tumor diameter, rates of microcarcinomas and incidentality were similar. Of all cancer types, 88.8% in geriatric and 93.9% in non-geriatric group were papillary thyroid cancer (p = 0.028). Hurthle cell cancer constituted 3.9 and 1.1% of carcinomas in geriatric and non-geriatric patients, respectively (p = 0.015); 2.0 and 0.2% of tumors in geriatric and non-geriatric group were anaplastic, respectively (p = 0.012). Capsular and vascular invasion, extrathyroidal extension, persistence and recurrence rates were similar. CONCLUSIONS Rates of anaplastic cancer and Hurthle cell cancer which is known to have worser prognosis among other differentiated thyroid cancers are increased in geriatric ages. Cytological evaluation of thyroid nodules should strongly be considered due to increased tendency for aggressive tumor types in these patients.
Collapse
Affiliation(s)
- F D Dellal
- Department of Endocrinology and Metabolism, Ataturk Training and Research Hospital, Universiteler Mahallesi Bilkent Caddesi No:1, 06800, Cankaya, Ankara, Turkey.
| | - D Özdemir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - A A Tam
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - H Baser
- Department of Endocrinology and Metabolism, Ataturk Training and Research Hospital, Universiteler Mahallesi Bilkent Caddesi No:1, 06800, Cankaya, Ankara, Turkey
| | - H Tatli Dogan
- Department of Pathology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - O Parlak
- Department of Surgery, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - R Ersoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - B Cakir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| |
Collapse
|
13
|
Age-based disparities in the use of total thyroidectomy for papillary thyroid carcinoma. Clin Transl Oncol 2017; 19:1253-1259. [PMID: 28439795 DOI: 10.1007/s12094-017-1663-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Elderly patients may be less likely than younger patients to receive indicated therapy. We hypothesized that older patients with papillary thyroid carcinoma (PTC) would be less likely to receive total thyroidectomy (TT) than their younger counterparts. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results database were queried for adult patients diagnosed with PTC from 2000 through 2009. Patients were categorized according to whether they received a TT or less than a total thyroidectomy (<TT). We used multivariate logistic regression to predict the use of <TT. The likelihood of undergoing <TT was reported as odds ratios (OR) with 95% confidence intervals (CI). RESULTS Of the 67,961 patients identified with PTC, 51,276 (75%) received TT, 14,750 (22%) <TT and 1935 (3%) no surgery. On multivariate analysis, advancing age increased the likelihood of receiving <TT (age 45-54 OR 1.15, CI [1.09-1.20]; age 55-64 OR 1.20, CI [1.14-1.26]; age 65-74 OR 1.40, CI [1.32-1.49]; 75-84 OR 1.80, CI [1.65-1.95]; ≥85 OR 3.01, CI [2.51-3.62], all p < 0.001). CONCLUSIONS Older patients with PTC are less likely to receive TT. Further research is needed to assess if older patients are negatively impacted by less complete surgery.
Collapse
|
14
|
Chereau N, Trésallet C, Noullet S, Godiris-Petit G, Tissier F, Leenhardt L, Menegaux F. Prognosis of papillary thyroid carcinoma in elderly patients after thyroid resection: A retrospective cohort analysis. Medicine (Baltimore) 2016; 95:e5450. [PMID: 27893690 PMCID: PMC5134883 DOI: 10.1097/md.0000000000005450] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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.
Collapse
Affiliation(s)
| | | | | | | | - Frederique Tissier
- Department of Endocrinology, Hôpital de la Pitié Salpêtrière – Université Pierre et Marie Curie (Paris VI) – APHP, Paris, France
| | | | | |
Collapse
|
15
|
Shi RL, Qu N, Liao T, Wei WJ, Wang YL, Ji QH. The Trend of Age-Group Effect on Prognosis in Differentiated Thyroid Cancer. Sci Rep 2016; 6:27086. [PMID: 27272218 PMCID: PMC4897617 DOI: 10.1038/srep27086] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 05/10/2016] [Indexed: 01/06/2023] Open
Abstract
Age has been included in various prognostic scoring systems for differentiated thyroid cancer (DTC). The aim of this study is to re-examine the relationship between age and prognosis by using Surveillance, Epidemiology, and End Results (SEER) population-based database. We identified 51,061 DTC patients between 2004 and 2012. Patients were separated into 10-year age groups. Cancer cause-specific survival (CSS) and overall survival (OS) data were obtained. Kaplan-Meier and multivariable Cox models were built to analyze the outcomes and risk factors. Increasing age gradient with a 10-year interval was associated with the trend of higher proportions for male gender, grade III/IV and summary stage of distant metastases. Both CSS and OS continued to worsen with increasing age, being poorest in in the oldest age group (≥71); multivariate analysis confirmed that CSS continued to fall with each age decade, significantly starting at 60 years (HR = 7.5, 95% 1.0–54.1, p = 0.047) compared to the young group (≤20). Similarly, multivariate analysis suggested that OS continued worsening with increasing age, but starting at 40 years (HR = 3.7, 95% 1.4–10.1, p = 0.009) compared to the young group. The current study suggests that an age exceeding 60 years itself represents an unfavorable prognostic factor and high risk for cancer-specific death in DTC.
Collapse
Affiliation(s)
- Rong-Liang Shi
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Department of General surgery, Minhang Hospital, Fudan University, Shanghai 201199, China
| | - Ning Qu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Tian Liao
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Wen-Jun Wei
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yu-Long Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Qing-Hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| |
Collapse
|
16
|
Petrulea MS, Lencu C, Piciu D, Lisencu CI, Georgescu CE. Challenges of thyroid cancer management in amiodarone-treated patients: a case report. Med Pharm Rep 2016; 88:550-4. [PMID: 26733755 PMCID: PMC4689250 DOI: 10.15386/cjmed-502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/08/2015] [Indexed: 02/02/2023] Open
Abstract
Thyroid carcinoma (TC) is the most common endocrine malignancy. Although the overall prognosis for patients with TC is good, up to 20–30% of patients have recurrent or persistent disease after conventional therapy by surgical resection and radioactive iodine (RAI). Amiodarone is a highly efficient anti-arrhythmic drug with a very long half-life, so it may interfere with RAI many months after the drug withdrawal. This case report mirrors the challenges of thyroid cancer management in an amiodarone-treated patient.
Collapse
Affiliation(s)
- Mirela Sanda Petrulea
- Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Codruta Lencu
- Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Doina Piciu
- Nuclear Medicine Department, Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | - Cosmin Ioan Lisencu
- Department of Surgery, Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | - Carmen Emanuela Georgescu
- Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
17
|
Tartaglia F, Russo G, Sgueglia M, Blasi S, Tortorelli G, Tromba L, Krizzuk D, Merola R. Total thyroidectomy in geriatric patients: a retrospective study. Int J Surg 2014; 12 Suppl 2:S33-S36. [PMID: 25167851 DOI: 10.1016/j.ijsu.2014.08.386] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 11/19/2022]
Abstract
In the English literature there is no single definition that identifies elderly patients. In our retrospective study, we divided total thyroidectomized patients operated on from 2000 to 2010 in the Department of Surgical Sciences of the "Sapienza" University of Rome, in two groups: group 1 consists of 448 patients over 65 years and group 2 consists of 1275 patients under 65 years. We compared both groups in terms of indications for surgery, histological diagnoses, postoperative complications (laryngeal nerv palsy, hypocalcemia, bleeding and seroma) and mortality. The results showed no statistically significant differences between the two groups with respect to the type of surgical indication, the type of comorbidities, the incidence of postoperative complications and perioperative mortality. The only data discordant with those in the international literature was the incidence of neoplastic disease that is found to be slightly greater in group 2. In conclusion, total thyroidectomy in patients over 65 years is a safe procedure and is not burdened with a higher percentage of postoperative complications, even if requires a careful preoperative assessment of risk factors related to comorbidity.
Collapse
Affiliation(s)
- F Tartaglia
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
| | - G Russo
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
| | - M Sgueglia
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
| | - S Blasi
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
| | - G Tortorelli
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
| | - L Tromba
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
| | - D Krizzuk
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
| | - R Merola
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
| |
Collapse
|
18
|
Calò PG, Medas F, Loi G, Erdas E, Pisano G, Nicolosi A. Differentiated thyroid cancer in the elderly: our experience. Int J Surg 2014; 12 Suppl 2:S140-S143. [PMID: 25183640 DOI: 10.1016/j.ijsu.2014.08.362] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/23/2014] [Accepted: 06/15/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The objective of this retrospective study was to investigate clinical and pathologic characteristics of differentiated thyroid cancer in elderly patients and to evaluate the results of surgical treatment in this age group. METHODS The clinical records of patients who underwent total thyroidectomy between 2002 and 2012 with histopathological diagnosis of differentiated thyroid cancer were analyzed. Patients were divided into two groups: those 65 years old or older were included in group A (101), those younger in group B (354). RESULTS The mean surgical time was 100.9 ± 30.5 min in group A and 100.7 ± 27.6 in B. Postoperative stay was significantly longer in group A (2.8 ± 1.5 days vs 2.4 ± 0.7; p < 0.01). Classic papillary carcinoma was more frequent in group B, whereas follicular variant of papillary carcinoma and tall cell carcinoma in A. In group B node metastases were nearly twice. In Group A transient hypoparathyroidism occurred in 25 patients (24.8%), permanent hypoparathyroidism in 4 (4%), hematoma in 6 (5.9%), recurrent nerve palsy in 2 (2%), and wound infection in 2 (2%). In group B transient and permanent hypoparathyroidism occurred in 48 and 7 patients respectively (13.6% and 2%), hematoma in 4 (1.1%), recurrent nerve palsy in 5 (1.4%), and wound infection in 1 (0.3%). CONCLUSIONS Differentiated thyroid carcinoma is more aggressive in elderly patients for biological causes connected to age and to histotype but also for the diagnostic delay. Thyroid surgery in elderly patients is safe when the procedure is carried out by experienced staff. Total thyroidectomy is the surgical operation of choice.
Collapse
Affiliation(s)
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Giulia Loi
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Giuseppe Pisano
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Angelo Nicolosi
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| |
Collapse
|
19
|
Wang Z, Zhang H, Zhang P, He L, Dong W. Diagnostic Value of Ultrasound-detected Calcification in Thyroid Nodules. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2014. [DOI: 10.47102/annals-acadmedsg.v43n2p102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: This study analyses the diagnostic value of ultrasonography (US) detection
for calcification in thyroid nodules. Materials and Methods: We analysed the preoperative
US findings and clinical characteristics of 577 malignant and 3434 benign thyroid
patients who underwent surgery in our hospital. Results: The malignant rate in patients
with microcalcification hyperechoic and tiny calcification foci ≤2 mm in diameter was
significantly higher than the non-calcification and other calcification group (P <0.001). The
malignant rate in single calcification nodule was significantly higher than that in multiple
nodule group (P <0.01). Most of the patients (37/39) with lymph node calcification were
malignant. The malignant rate of calcification and microcalcification was significantly
higher in patients <45 years old than in older patients (P <0.05). Conclusion: Compared
with other calcifications, microcalcification should be a better predictor of thyroid
carcinoma. Malignancy should be highly suspected in patients with single calcification
nodule, especially with lymph node calcification. Patients younger than 45 years of age
with calcification or microcalcification have a greater risk for thyroid carcinoma.
Key words: Age, Single nodule, Thyroid carcinoma, Ultrasonography
Collapse
Affiliation(s)
- Zhihong Wang
- The First Hospital of China Medical University, China
| | - Hao Zhang
- The First Hospital of China Medical University, China
| | - Ping Zhang
- The First Hospital of China Medical University, China
| | - Liang He
- The First Hospital of China Medical University, China
| | - Wenwu Dong
- The First Hospital of China Medical University, China
| |
Collapse
|
20
|
Retornaz F, Castinetti F, Molines C, Oliver C. La thyroïde de la personne âgée (partie 2). Rev Med Interne 2013; 34:694-9. [DOI: 10.1016/j.revmed.2012.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 10/30/2012] [Accepted: 11/26/2012] [Indexed: 11/24/2022]
|
21
|
Ng SH, Wong KP, Lang BHH. Thyroid surgery for elderly patients: are they at increased operative risks? J Thyroid Res 2012; 2012:946276. [PMID: 22970410 PMCID: PMC3431118 DOI: 10.1155/2012/946276] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 06/20/2012] [Indexed: 11/18/2022] Open
Abstract
An increasing elderly population, a rising incidence of differentiated thyroid carcinoma (DTC), and a rising incidence of benign nodular disease with age are all contributing to a rise in thyroid operations for the elderly. Literature review on the outcome and safety of thyroid surgery in elderly patients has been filled with conflicting results and this subject remains controversial. Although most single-institution studies conducted by high-volume surgeons did not find significant differences of complication rates in elderly when compared with younger cohorts, they often lacked the power necessary to identify subtle differences and suffered from various selection and referral biases. Recent evidence from large population-based studies concluded that thyroid surgery in the elderly was associated with higher complication rates. One of the major contributing factors for the increased complication rate was because most elderly patients suffered from many preexisting comorbidities. Therefore, elderly patients who have abnormal thyroid findings should complete a thorough preoperative workup and better postoperative care after undergoing any thyroid surgery. Furthermore, these high-risk patients would benefit if they could be referred to high-volume, specialized surgical units early. In this systemic review, we aimed to evaluate different issues and controversies in thyroidectomy for elderly patients.
Collapse
Affiliation(s)
- Sze-How Ng
- Breast and Endocrine Unit, Department of Surgery, Kuala Lumpur Hospital, 50586 Kuala Lumpur, Malaysia
| | - Kai-Pun Wong
- Division of Endocrine Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Brian Hung-Hin Lang
- Division of Endocrine Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| |
Collapse
|
22
|
Howell GM, Carty SE, Armstrong MJ, Lebeau SO, Hodak SP, Coyne C, Stang MT, McCoy KL, Nikiforova MN, Nikiforov YE, Yip L. Both BRAF V600E mutation and older age (≥ 65 years) are associated with recurrent papillary thyroid cancer. Ann Surg Oncol 2011; 18:3566-71. [PMID: 21594703 DOI: 10.1245/s10434-011-1781-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE This study was designed to examine the aggressive features of BRAF-positive papillary thyroid cancer (PTC) and association with age. METHODS We compared the clinicopathologic parameters and BRAF V600E mutation status of 121 elderly (age ≥65 years) PTC patients who underwent thyroidectomy from January 2007 to December 2009 to a consecutive cohort of 98 younger (age <65 years) PTC patients. RESULTS Younger and elderly PTC patients had similar incidences of BRAF-positive tumors (41% vs. 38%; p = 0.67). The elderly cohort was more likely to have smaller tumors (mean 1.6 vs. 2.1 cm; p = 0.001), present with advanced TNM stage (36% vs. 19%; p = 0.008), and have persistent/recurrent disease (10% vs. 1%; p = 0.006). BRAF-positive status was associated with PTC that were tall cell variant (p < 0.001), had extrathyroidal extension (p < 0.001), lymph node involvement (p = 0.008), advanced (III/IV) TNM stage (p < 0.001), and disease recurrence (p < 0.001). Except for lymph node involvement, the association between aggressive histology characteristics at presentation and BRAF-positive PTC also was observed within the age-defined cohorts. In short-term follow-up (mean, 18 months), persistent/recurrent PTC was much more likely to occur in patients who were both BRAF-positive and elderly (22%). CONCLUSIONS BRAF mutations are equally present in younger and older patients. Aggressive histology characteristics at presentation are associated with BRAF-positive PTC, irrespective of age. However, the well-established association of BRAF with recurrence is limited to older (age ≥65 years) patients.
Collapse
Affiliation(s)
- Gina M Howell
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Toniato A, Bernardi C, Piotto A, Rubello D, Pelizzo MR. Features of papillary thyroid carcinoma in patients older than 75 years. Updates Surg 2011; 63:115-8. [PMID: 21416286 DOI: 10.1007/s13304-011-0060-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 03/03/2011] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the prognosis in elderly patients affected by papillary thyroid carcinoma. A retrospective review was conducted on 1,407 patients operated on for papillary thyroid carcinoma at our Department from 1990 to 2007. We analyzed the frequency, the stage, the treatment, the recurrence and the survival in a group of patients aged 75 years or more when compared with a group of patients younger. Among 1,407 patients affected by papillary thyroid carcinoma, 117 (8.3%) were older than 75 years while 1,290 (91.7%) patients were younger. There was no statistical difference between the two groups in frequency of papillary histotype and type of surgery. In the older group, the incidence of anaplastic cancer was higher, p < 0.001. The rate of IV stage was 3.8% in younger versus 15.4% in older patients, p < 0.001. The incidence of recurrence was 6.1% versus 17.9%, p < 0.001, in young and elderly patients, respectively. At a mean follow-up of 8.7 years (range 2-19 years) the overall 10 and 15-year survival in younger patients was 91.3 and 88.7%, while in the older group was 71.8 and 63.9%, respectively. The Kaplan-Meier curve showed a statistically significant difference of survival rate in the two groups (p < 0.0001). Although papillary thyroid cancer is widely considered a lymph-tropic tumor, it seems to have a stronger attitude to distant metastases in elderly patients with a worse prognosis due to a more advanced stage.
Collapse
Affiliation(s)
- Antonio Toniato
- Surgical Pathology, Department of Medical and Surgical Sciences, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
| | | | | | | | | |
Collapse
|
24
|
Matsuyama H, Sugitani I, Fujimoto Y, Kawabata K. Indications for thyroid cancer surgery in elderly patients. Surg Today 2009; 39:652-7. [DOI: 10.1007/s00595-008-3951-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 08/12/2008] [Indexed: 11/24/2022]
|