Cause of Death Among Patients With Thyroid Cancer: A Population-Based Study

Diagnostic accuracy of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in differentiating thyroid tumors: A systematic review and meta-analysis

BACKGROUND

Thyroid neoplasms include a range of lesions, most of which are benign, though some may progress to or present as malignant. Diagnostic tools like FNAB, ultrasound, and hormone analysis are commonly used, though they have limitations. Recently, peripheral blood markers have been explored for their potential in differentiating thyroid lesions, despite controversy evidence. This review evaluates the diagnostic utility of NLR and PLR in thyroid lesions.

METHODS

We systematically searched all relevant articles on PubMed, Science Direct, Cochrane Library, and gray literature, including Google Scholar, for studies on the diagnostic utility of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in thyroid lesions. Two researchers independently screened articles, and study quality was assessed using the QUADAS 2 tool. A random-effects model calculated pooled sensitivity and specificity, while the area under the HSROC curve summarized diagnostic accuracy. Heterogeneity was evaluated with Higgins' I² statistic, and publication bias was assessed using the MIDAS command. Subgroup analyses by sample size, gender distribution, cutoff values, and carcinoma types explored sources of heterogeneity.

RESULTS

A total of 12 studies were included in the final meta-analysis, with 9 focusing on NLR and 6 on PLR. Most of these studies were retrospective in design. The pooled sensitivity and specificity of NLR were 75% (95% CI: 65-82%) and 62% (95% CI: 42-75%), respectively. For PLR, the overall sensitivity and specificity were 70% (95% CI: 61-78%) and 57% (95% CI: 46-66%), respectively. The diagnostic accuracy, based on the area under the HSROC curve (AUC), was 0.75 (95% CI: 0.71-0.79) for NLR and 0.69 (95% CI: 0.65-0.73) for PLR. These results indicate that NLR has better diagnostic accuracy than PLR in distinguishing between benign and malignant thyroid lesions.

CONCLUSION

While the NLR demonstrates better diagnostic utility than the PLR in distinguishing between benign and malignant thyroid lesions, its standalone diagnostic accuracy remains moderate. Therefore, we recommend using these markers as complementary tools alongside other standard diagnostic modalities until further studies provide more definitive evidence. Thyroid neoplasm is a type of cancer which arises from the thyroid parenchymal cell and affects the thyroid gland. The disease encompasses a variety of lesion, including benign adenomas to malignant carcinomas [1]. The majority of thyroid glands are noncancerous and are mostly benign. In some contexts, thyroid adenomas may transform into carcinomas as the nonfunctional adenomas possess oncogene mutations [2]. Overall, 5% of thyroid nodules are malignant. Notably, approximately 20% of follicular adenomas have the potential to progress into follicular carcinomas [3]. The common thyroid malignancies include, papillary, follicular, medullary and anaplastic types, which varies based on the aggressiveness of the cancer, which are highly variable clinical features; some may be indolent and slow progressing while others may be highly aggressive tumors with a high mortality rate [4,5]. Globally, thyroid cancer cases are increasing over time. Approximately 18.3 million thyroid cases were reported with a high prevalence rate in China and United States [6]. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used and performed for this systematic review and meta-analysis. This review was registered on PROSPERO with registration number of CRD42024559798.

Analysis of immediate 503 thyroid carcinoma deaths: trend of single institution in 2005-2024

Background

This study aimed to investigate the changes in histological types and causes of death associated with thyroid carcinoma (TC) before and after the introduction of systemic drug therapy.

Methods

The records of 503 deceased patients treated for TC and with death from TC between January 2005 and June 2024 were reviewed in this retrospective cohort study. Multivariate logistic regression was applied to assess whether the number of patients with anaplastic TC (ATC) at diagnosis and the number of local-related deaths changed before and after the introduction of lenvatinib (i.e. 2005-2014 vs 2015-2024).

Results

Of the 503 patients, 157 (31%) had ATC, 253 (50%) had papillary TC (PTC), 67 (13%) had follicular TC (FTC), 17 (3%) had poorly differentiated TC, and nine (2%) had medullary TC. Respiratory insufficiency was the most common fatal condition, occurring in 192 cases (38%), followed by local-related death in 98 cases (19%) and brain-related conditions in 22 cases (4%). We found no difference in the frequency of patients with ATC at diagnosis (32 vs 30%; P-value = 0.772) and the frequency of local-related deaths (19 vs 20%; P-value = 0.736) between 2005-2014 and 2015-2024. These findings were supported by multivariate logistic regression models that adjusted for other covariates (adjusted P-value = 0.436 and 0.353, respectively).

Conclusions

ATC, including anaplastic transformation from PTC and FTC, still accounts for approximately 40% of thyroid cancer deaths after the introduction of systemic drug therapy. Respiratory insufficiency is the most common immediate cause of death.

Clinical characteristics, surgical approaches, and prognosis of follicular and papillary thyroid cancer in children and adolescents: a retrospective cohort study

PURPOSE

Follicular and papillary thyroid cancers are prevalent endocrine tumors in children and adolescents. This study seeks to highlight distinctions between papillary thyroid cancer  (PTC) and follicular thyroid cancer  (FTC) to inform subtype-specific guidelines.

PATIENTS AND METHODS

Utilizing data from the SEER database, this study contrasts the clinical features, survival rates, causes of death, TNM staging, and surgical interventions for pediatric and adolescent patients diagnosed with PTC and FTC from 2000 to 2020.

RESULTS

We analyzed 3068 pediatric and adolescent patients with differentiated thyroid cancer (DTC). Since 2005, PTC incidence has increased, while FTC remains stable. Both subtypes exhibit excellent survival rates; FTC shows near-perfect outcomes, and PTC's overall survival (OS) at 2, 5, and 10 years is 99.6, 99.2, and 98.5%, respectively. Thyroid cancer accounted for only 20.9% of deaths among PTC patients. Significant differences in T and N staging were observed. Regarding surgery, 70% of FTC patients underwent total or near-total thyroidectomy compared to 90% of PTC patients. Lymph node dissection was performed in 41.7% of FTC and 77.5% of PTC patients, indicating distinct surgical approaches.

CONCLUSION

Pediatric and adolescent patients with FTC and PTC have excellent prognoses. The extent of thyroidectomy and criteria for prophylactic central lymph node dissection should be tailored specifically for FTC and PTC, rather than generalizing under DTC.

CLINICAL TRIAL INFORMATION

NCT06592118.

Disparities in Thyroid Cancer Mortality Across Racial and Ethnic Groups: Assessing the Impact of Socioeconomic, Clinicopathologic, and Treatment Variations

BACKGROUND

Thyroid cancer remains a significant public health concern, with disparities in mortality rates observed across racial/ethnic groups. We quantified the extent to which socioeconomic, clinicopathologic, and treatment variations explain racial/ethnic disparities in thyroid cancer mortality.

METHODS

We studied a cohort of 109,981 thyroid cancer patients diagnosed from 2006 to 2018 using the United States Surveillance, Epidemiology, and End Results database. We used multivariable logistic regression to assess the association of race/ethnicity with treatment status. We also performed mediation analyses to estimate how much the racial/ethnic differences in thyroid cancer-specific mortality were explained by variations in treatment and clinicopathologic and socioeconomic factors.

RESULTS

Non-hispanic (NH) Black patients were more likely to not receive the recommended surgical resection than NH White patients (adjusted odds ratio [aOR] 1.10, 95% confidence interval [CI] 1.02-1.20). NH Black patients had a significantly higher risk of all-cause mortality compared with NH White patients (adjusted hazards ratio [aHR] 1.19, 95% CI 1.07-1.31). Mediation analysis showed that socioeconomic status significantly explained 48.7% (indirect effect HR 1.07, 95% CI 1.01-1.14) of the difference in thyroid cancer-specific mortality between NH Black and NH White patients.

CONCLUSIONS

This study found that race/ethnicity was associated with treatment status and the risk of mortality among patients diagnosed with thyroid cancer. Moreover, clinicopathologic and socioeconomic factors were identified as the most crucial mediators that explained the excess mortality among minority groups. These findings provide insight into the pathways through which disparities in thyroid cancer mortality in NH Black and Hispanic thyroid patients could operate.

Identification of Risk Factors for Cause-specific Mortality in Advanced Papillary Thyroid Cancer and Construction of a Competing Risk Model: A SEER-Based Study

IntroductionPapillary thyroid carcinoma (PTC) generally has a favorable prognosis, yet advanced PTC has higher recurrence and mortality risks. This study constructs and validates a competing risk model for cause-specific mortality (CSM) in advanced PTC.MethodsStage III-IV PTC cases (AJCC 7th edition) from the SEER database (2010-2015) were analyzed. Patients were split into training and validation sets (7:3). Univariate and multivariate analyses identified independent CSM predictors, forming the basis of a risk prediction nomogram. Model accuracy was evaluated via the C-index and calibration curve.ResultsA total of 11 913 advanced PTC cases were analyzed. Competing risk model analysis unraveled that age, race, sex, grade, stage, T stage, M stage, surgery, chemotherapy, and tumor size were risk factors for CSM in advanced PTC. The AUC values of the constructed nomogram in predicting 3-, 5-, and 8-year survival were 0.931 (95%CI 0.909-0.953), 0.915 (95%CI 0.897-0.933), and 0.902 (95%CI 0.883-0.92) in the training set, and 0.948 (95%CI 0.916-0.981), 0.93 (95 % CI 0.903-0.957), and 0.917 (95%CI 0.891-0.943) in the validation cohort, respectively. The C-index of the nomogram for advanced PTC was 0.908 and 0.921 in the training and validation cohorts, respectively. The calibration curve unveiled that the predicted estimates by the model were basically congruent with the observed values, suggesting a high degree of calibration.ConclusionThe competing risk model offers a reliable tool for assessing prognosis in advanced PTC, supporting personalized treatment and risk management in clinical practice.

Role of Cancer History in Cardiovascular Mortality Among Different Age-group Patients With Differentiated Thyroid Cancer

Background

Cardiovascular disease (CVD) is the leading cause of noncancer-related mortality among differentiated thyroid cancer (DTC) survivors, which accounts for a large portion of subsequent primary malignancies in childhood cancer survivors. This study aims to assess the risk of cardiovascular mortality among DTC as a second primary malignancy (DTC-2) patients compared with DTC as a first primary malignancy (DTC-1) and the general population.

Methods

Using the Surveillance, Epidemiology, and End Results database, we conducted a population-based cohort study including 159 395 DTC-1 and 20 010 DTC-2 patients diagnosed older than 30 between 1975 and 2020 and the corresponding US population (71 214 642 person-years; 41 420 893 cardiovascular deaths). Compared with general-population and DTC-1 patients, we calculated incidence rate ratios (IRRs) of cardiovascular deaths among DTC-2 patients using Poisson regression. To adjust for unmeasured confounders, we performed a nested, case-crossover analysis among DTC-2 patients who died from CVD.

Results

Although DTC-2 patients had a comparable risk compared with the population (IRR 1.01) and a mildly increased risk of cardiovascular mortality compared with DTC-1 patients (IRR 1.26), the association was pronounced among individuals aged 30 to 74 years, especially 30 to 44 years (DTC-2 vs population: IRR 8.89; DTC-2 vs DTC-1: IRR 3.00). The risk elevation was greatest within the first month after diagnosis, compared with the population. The case-crossover analysis confirmed these results.

Conclusion

DTC-2 patients are at increased risk of cardiovascular mortality. Clinicians should carefully monitor CVD and manage other CVD-related factors, such as exogenous thyroxine and emotional distress, for DTC-2 patients, especially for those under 75 years.

Novelty and Impact Statements

This study is the first comprehensive investigation into the cardiovascular mortality of DTC-2, revealing a higher risk compared to DTC-1 and the general population, especially for cases between 30 and 74 years old. The risk elevation was greatest within the first month after diagnosis. These findings emphasize the restriction of thyroid hormone suppression therapy and reinforce stress management to prevent premature DTC-2 patients from cardiovascular death.

Cause of death among gastric cancer survivors in the United States from 2000 to 2020

A number of studies have been conducted to explore the survival of gastric cancer (GC) patients, while studies about non-cancer causes of death in patients with GC are not well-conducted. The aim of this study was to deeply investigate the causes of death (COD) in GC patients, especially non-cancer ones. The Surveillance, Epidemiology and End Results (SEER) database was used to extract information including demographics, tumor characteristics and causes of death of GC patients meeting the inclusion criteria. The patients were stratified by demographic and clinical parameters. Standardized mortality ratios (SMRs) were calculated for all causes of death at different follow-up periods. A total of 116,437 patients with GC diagnosed between 2000 and 2020 were retrieved from the SEER database. Of these, 85,827 deaths occurred during the follow-up period, most of which occurred within 1 year after GC diagnosis. GC (n = 49,746; 58%) was the leading COD, followed by other cancer (n = 21,135; 25%) and non-cancer causes (n = 14,946; 17%). Diseases of heart were the most common non-cancer cause of death, accounting for 30%, followed by cerebrovascular diseases (n = 917; 6%) and chronic obstructive pulmonary disease (n = 900; 6%). Although gastric cancer remains the most common cause of death in gastric cancer patients, it should not be ignored that the risk of non-cancer causes tends to increase with the length of the latency period. These findings may provide important insights into the healthcare management of gastric cancer patients at various follow-up intervals.

Risk of suicide in patients with thyroid cancer: protocol for a systematic review and meta-analysis

INTRODUCTION

In recent years, the incidence of thyroid cancer has increased manyfold and young adults, who have a greater financial burden and occupational stress, comprise a large number. Previous studies have shown mixed results, even distinct results, on suicide rates among thyroid cancer survivors. As the overdiagnosis and overtreatment of thyroid cancer has gradually become a topical issue, the study aims to summarise the risk of suicide among patients with thyroid cancer to provide robust evidence of the effects of thyroid cancer on suicide.

METHODS AND ANALYSIS

A total of six databases (MEDLINE, Embase, Web of Science Core Collection, PsycINFO, CINAHL and Google Scholar) will be searched according to MeSH, subheadings, and free words, and the planned search date is 31 Jnauary 2024. The search strategy had three parts, such as suicide, cancer and epidemiological studies, moreover, we will collect the detailed suicide information by reviewers' extraction. Standard mortality ratio (SMR) was used as the outcome measure, when SMRs were not available, the risk ratio, HR and detailed number of suicides were extracted to calculate the SMRs.

ETHICS AND DISSEMINATION

The Institutional Review Board of Peking University People's Hospital provided ethical approval exemption and approved the data collection and subsequent analyses in accordance with the Declaration of Helsinki as revised in 2013.

PROSPERO REGISTRATION NUMBER

CRD42023445542.

Suicide among Cancer Patients: Current Knowledge and Directions for Observational Research

Cancer is a major public health concern associated with an increased risk of psychosocial distress and suicide. The reasons for this increased risk are still being characterized. The purpose of this study is to highlight existing observational studies on cancer-related suicides in the United States and identify gaps for future research. This work helps inform clinical and policy decision-making on suicide prevention interventions and ongoing research on the detection and quantification of suicide risk among cancer patients. We identified 73 peer-reviewed studies (2010-2022) that examined the intersection of cancer and suicide using searches of PubMed and Embase. Overall, the reviewed studies showed that cancer patients have an elevated risk of suicide when compared to the general population. In general, the risk was higher among White, male, and older cancer patients, as well as among patients living in rural areas and with lower socioeconomic status. Future studies should further investigate the psychosocial aspects of receiving a diagnosis of cancer on patients' mental health as well as the impact of new treatments and their availability on suicide risk and disparities among cancer patients to better inform policies.

Non cancer causes of death after gallbladder cancer diagnosis: a population-based analysis

Mortality from non cancer causes in patients with gallbladder cancer (GBC) still unclear. This study evaluated the causes and risk factors of non cancer death during different follow-up periods after GBC diagnosis. Non cancer causes of death for GBC patients diagnosed between 2000 and 2017 in Surveillance, Epidemiology and End Results database were analyzed and standardized mortality rates (SMR) for each non cancer death were calculated. Predictors for non cancer death were identified through multivariate competing risk analysis. A total 11,927 GBC patients were identified for further analysis, 9393 died during follow up. The largest proportion of non cancer deaths occurred > 3 years after diagnosis (39.4%). Most common non cancer cause were cardiovascular disease (43.3%), followed by other cause of death (34.4%) and infectious diseases (8.6%). Compared with US general population, GBC patients has higher risk of death from disease of heart (SMR, 1.58; 95%CI, 1.41-1.75), septicemia (SMR,3.21; 95%CI, 2.27-4.40), diabetes mellitus (SMR,1.97; 95%CI, 1.43-2.63), alone with other causes. Non cancer causes accounted for a significant proportion of deaths during the follow-up period after GBC diagnosis. The risk of non cancer death is higher in GBC patients than in the general population. Our study provides comprehensive assessment of death from non cancer cause in GBC patients, which has important implications for health management in GBC patients.

Thyroid and renal cancers: A bidirectional association

There is a deep interrelation between the thyroid gland and the kidney parenchyma, with dysfunction of the first leading to significant changes in renal metabolism and vice versa. Given the recognition of cancer as a systemic disease, the raise of thyroid tumors and the common association of several malignancies, such as breast cancer, prostate cancer, colorectal cancer, and other, with an increased risk of kidney disease, public health alert for these conditions is warranted. A systematic review of the current evidence on the bidirectional relationship between thyroid and renal cancers was conducted including 18 studies, highlighting patient's characteristics, histology, time for secondary malignancy to develop from the first diagnosis, treatment, and follow-up. A total of 776 patients were identified; median age was 64 years (range: 7-76 years). Obesity and family history were identified as the most common risk factors, and genetic susceptibility was suggested with a potential strong association with Cowden syndrome. Controversy on chemo and radiotherapy effects was found, as not all patients were previously exposed to these treatments. Men were more likely to develop kidney cancer after a primary thyroid malignancy, with 423/776 (54%) experiencing renal disease secondarily. Median time after the first malignancy was 5.2 years (range: 0-20 years). With the advancement of current oncological therapy, the prognosis for thyroid cancer patients has improved, although there has been a corresponding rise in the incidence of multiple secondary malignancy within the same population, particularly concerning the kidney. Surgery can achieve disease-free survival, if surveillance follow-up allows for an early localized form, where radical treatment is recommended.

Cardiovascular disease related death among patients with esophagus cancer: A population-based competing risk analysis

The proportion of non-cancer death in patients with esophagus cancer (EC) still increasing, especially cardiovascular disease (CVD) related death. The aim of this study was assess non-cancer causes of death and identified independent risk factors of CVD related death in EC patients. Patients diagnosed with EC were extracted from the Surveillance, Epidemiology, and End Result database (SEER) database for analysis. Standardized mortality rates (SMRs) for non-EC deaths were calculated, the risk of death were assessed and compared with US general population. Multivariate competitive risk analysis were performed to select independent risk factors for death from CVD in EC patients. A total of 43739 EC patients were enrolled and 35139 died during follow-up, of which 4248 died from non-cancer cause of death. The risk of non-cancer death in EC patients was 2.27-fold higher than in the general population (SMR=2.27; 95% CI, 2.20-2.34). CVD were the most important cause of non-cancer death in EC patients, accounting for 43.4% of non-cancer of deaths. Compare with the general population, EC patients have higher risk of death from disease of heart (SMR, 2.24; 95% CI, 2.13-2.35), pneumonia and influenza (SMR, 2.92; 95% CI, 2.50-3.39), septicemia (SMR, 5.01; 95% CI, 4.30-5.79), along with other causes. Patients with advanced age and patients who received radiotherapy has higher risk of death caused by CVD, patients with female sex, poor differentiated and undifferentiated, regional and distant stage, married, diagnosed between 2010-2016 has lower risk of CVD related death, compared with patients without any treatment measures, patients received chemotherapy alone has lower risk of death from CVD. Non-cancer cause of death has become an important cause of death in EC patients. Improving public awareness of the major risk factors for non-cancer death is beneficial to the prevention and treatment of malignant tumors.

Suicide and Cardiovascular Death Among Patients With Multiple Primary Cancers in the United States

Background

Previous studies have demonstrated that patients with a cancer diagnosis have an elevated risk of suicide and cardiovascular death. However, the effects of the diagnosis of multiple primary cancers (MPCs) on the risk of suicide and cardiovascular death remain unclear. This study aimed to identify the risk of suicide and cardiovascular death among patients with MPCs in the United States.

Methods

Patients with a single or MPC(s) between 1975 and 2016 were selected from the Surveillance, Epidemiology, and End Results database in a retrospective cohort study. Mortality rates and standardized mortality ratios (SMRs) of suicides and cardiovascular diseases among patients with MPCs were estimated.

Results

Of the 645,818 patients diagnosed with MPCs included in this analysis, 760 and 36,209 deaths from suicides and cardiovascular diseases were observed, respectively. The suicide and cardiovascular-disease mortality rates were 1.89- (95% CI, 1.76-2.02) and 1.65-times (95% CI, 1.63-1.67), respectively, that of the general population. The cumulative mortality rate from both suicides and cardiovascular diseases among patients with MPCs were significantly higher than those of patients with a single primary cancer (Both p < 0.001). In patients with MPCs diagnosed asynchronously, the cumulative incidence rates of suicides and cardiovascular deaths were higher than those diagnosed synchronously. Among all MPCs, cancers of the pancreas and esophagus had the highest SMRs of suicide (5.98 and 5.67, respectively), while acute myeloid leukemia and brain cancer had the highest SMRs of cardiovascular diseases (3.87 and 3.62, respectively). The SMR of suicide was highest within 1 year after diagnosis, while that of cardiovascular diseases was highest 5 years after diagnosis.

Conclusions

This study showed that the mortality rates from suicides and cardiovascular diseases among patients with MPCs were higher than those with a single primary cancer. Therefore, our results underscore the need for psychological assessment and targeted preventive interventions for suicides and cardiovascular diseases among patients with MPCs.

Non-cancer Causes of Death Following Initial Synchronous Bone Metastasis in Cancer Patients

Purpose

To investigate the non-cancer causes of death (COD) in cancer patients with synchronous bone metastasis (BM) that is based on the Surveillance, Epidemiology, and End Results (SEER) database.

Methods

The retrospective cohort study included malignant cancer patients with synchronous BM diagnosed from 2010 to 2018 in the SEER database. The frequencies and proportion of non-cancer COD were calculated and analyzed in different genders, ages, and races subgroups.

Results

A total of 97,997 patients were deceased and included into the current study and 6,782 patients were died of non-cancer causes with a male predominance (N = 4,515, 66.6%). Around half of deaths (N = 3,254, 48.0%) occurred within 6 months after diagnosis while 721 patients were deceased after 3 years. Lung and bronchus cancer, prostate cancer, breast cancer, kidney and renal pelvis cancer, and liver cancer were proved to be the top five cancer types resulting in non-cancer caused death. Cardiovascular and cerebrovascular diseases were the leading non-cancer cause of death (N = 2,618), followed by COPD and associated conditions (N = 553) and septicemia, infectious and parasitic diseases (N = 544). Sub-analyses stratified by gender, age and race were performed and the similar results with slightly difference were observed.

Conclusions

Cardiovascular and cerebrovascular diseases were the main non-cancer cause of death in cancer patients with synchronous BM. Other non-cancer causes included COPD, septicemia, infectious and parasitic diseases, and so on. These findings should be considered by physicians. Physicians can counsel cancer patients with BM regarding survivorship with death causes screening and focus on prevention of non-cancer deaths.